Clonidine toxicity - Revision history

Danbot: Add MedicationDose SMW entries for naloxone and atropine; doses verified against toxicology references

2026-03-20T17:39:22Z

Add MedicationDose SMW entries for naloxone and atropine; doses verified against toxicology references

← Older revision		Revision as of 17:39, 20 March 2026
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	**[[IVF]]		**[[IVF]]
	**Vasopressors if not responsive to fluids		**Vasopressors if not responsive to fluids


			==Medication Dosing==
			*{{MedicationDose\|drug=Naloxone\|dose=0.4-2 mg IV, may repeat up to 10 mg\|route=IV\|context=CNS/respiratory depression reversal\|indication=Clonidine toxicity\|population=Adult\|notes=High doses (up to 10 mg) may be required; may need continuous infusion}}
			*{{MedicationDose\|drug=Atropine\|dose=0.5-1 mg\|route=IV\|context=Bradycardia\|indication=Clonidine toxicity\|population=Adult}}

	==Disposition==		==Disposition==

Addie: /* Management */

2021-09-20T13:33:17Z

Management

← Older revision		Revision as of 13:33, 20 September 2021
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	*Respiratory/neuro depression		*Respiratory/neuro depression
	**[[Naloxone]]		**[[Naloxone]]
	***High dose may be required (up to 10mg)<ref>Naloxone reversal of clonidine toxicity: dose, dose, dose		***High dose may be required (up to 10mg)<ref>Naloxone reversal of clonidine toxicity: dose, dose, dose. Donna L Seger, et al. Clin Toxicol (Phila). 2018.</ref>
	Donna L Seger, et al. Clin Toxicol (Phila). 2018.</ref>
	***Not always effective		***Not always effective
	***May require infusion, typically 2/3 effective treatment dose per hour		***May require infusion, typically 2/3 effective treatment dose per hour

Addie: /* Management */

2021-09-20T13:31:44Z

Management

← Older revision		Revision as of 13:31, 20 September 2021
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	*Respiratory/neuro depression		*Respiratory/neuro depression
	**[[Naloxone]]		**[[Naloxone]]
	***High dose may be required (up to 10mg)		***High dose may be required (up to 10mg)<ref>Naloxone reversal of clonidine toxicity: dose, dose, dose
			Donna L Seger, et al. Clin Toxicol (Phila). 2018.</ref>
	***Not always effective		***Not always effective
	***May require infusion, typically 2/3 effective treatment dose per hour		***May require infusion, typically 2/3 effective treatment dose per hour

Elcatracho: /* Clinical Features */

2021-01-18T23:20:11Z

Clinical Features

← Older revision		Revision as of 23:20, 18 January 2021
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	==Clinical Features==		==Clinical Features==
	*Note that initial presentation may stem from non-specific peripheral alpha1 agonism, and produce hypertension and reflex tachycardia		*Note that initial presentation may stem from non-specific peripheral alpha1 agonism, and produce hypertension and reflex tachycardia - will transition to bradycardia and hypotension when central effects take over
	*Cardiac (alpha2)		*Cardiac (alpha2)
	**Bradycardia		**Bradycardia

Mtjordan91: /* Background */

2019-11-20T20:37:33Z

Background

← Older revision		Revision as of 20:37, 20 November 2019
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	**Naphazoline (Naphcon)		**Naphazoline (Naphcon)
	**Apraclonidine		**Apraclonidine
	*α-2 and opioid receptor agonist		*α-2, imidazoline, and opioid receptor agonist
			**α2-agonism leads to activation of inhibitory neurons in the nucleus tractus solitarius causing decreased norepinephrine release, precipitating decreased sympathetic outflow
			**Agonism of imidazoline receptors in the brain can cause unconsciousness, hypotension, and bradycardia
			*Clonidine is used therapeutically for hypertension, opioid abuse, PTSD, and tobacco withdrawal; criminally, it has been used for drug-facilitated sexual assault

	==Clinical Features==		==Clinical Features==
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	**Hypotension		**Hypotension
	*Neuro		*Neuro
			**CNS depression (most common)
	**Lethargy (may progress to apnea)		**Lethargy (may progress to apnea)
	**Miotic pupils		**Miotic pupils
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	**Cheynes-Stokes respiration		**Cheynes-Stokes respiration
	**Periodic apnea		**Periodic apnea
			*Hypothermia
			*Can mimic opioid overdose
			**obtundation, miosis, respiratory depression, and hypothermia
			*Can mimic digoxin, Beta-blocker, or CCB toxicity with hypotension and bradycardia
			*Withdrawal from clonidine presents with tachycardia, hypertension, tremors, and agitation

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
			*Diagnosis is largely based on history and clinical picture; there is no readily available serum test
			*Serial ECGs
			*Continuous cardiac monitoring
			*Clonidine itself does not cause electrolyte derangements

	==Management==		==Management==
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	*[[Hypotension]]		*[[Hypotension]]
	**[[IVF]]		**[[IVF]]
			**Vasopressors if not responsive to fluids

	==Disposition==		==Disposition==

Kxl328: /* Clinical Features */

2018-09-22T23:07:49Z

Clinical Features

← Older revision		Revision as of 23:07, 22 September 2018
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	==Clinical Features==		==Clinical Features==
	*Cardiac		*Note that initial presentation may stem from non-specific peripheral alpha1 agonism, and produce hypertension and reflex tachycardia
			*Cardiac (alpha2)
	**Bradycardia		**Bradycardia
	**Hypotension		**Hypotension

Kramarsh: /* Management */

2018-03-27T16:18:50Z

Management

← Older revision		Revision as of 16:18, 27 March 2018
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	***High dose may be required (up to 10mg)		***High dose may be required (up to 10mg)
	***Not always effective		***Not always effective
			***May require infusion, typically 2/3 effective treatment dose per hour
	*[[Bradycardia]]		*[[Bradycardia]]
	**[[Atropine]]		**[[Atropine]]

Jesse: /* Clinical Features */

2017-09-01T04:53:47Z

Clinical Features

← Older revision		Revision as of 04:53, 1 September 2017
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	**Miotic pupils		**Miotic pupils
	**Respiratory depression		**Respiratory depression
			*Respiratory
			**Hypoventilation
			**Hypoxia
			**Cheynes-Stokes respiration
			**Periodic apnea

	==Differential Diagnosis==		==Differential Diagnosis==

Neil.m.young: Text replacement - "Alpha" to "α"

2017-07-24T01:12:20Z

Text replacement - "Alpha" to "α"

← Older revision		Revision as of 01:12, 24 July 2017
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	**Naphazoline (Naphcon)		**Naphazoline (Naphcon)
	**Apraclonidine		**Apraclonidine
	*~~Alpha~~-2 and opioid receptor agonist		*α-2 and opioid receptor agonist

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Management */

2016-11-10T14:15:13Z

Management

← Older revision		Revision as of 14:15, 10 November 2016
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	==Management==		==Management==
	*Respiratory/neuro depression		*Respiratory/neuro depression
	**Naloxone		**[[Naloxone]]
	***High dose may be required (up to 10mg)		***High dose may be required (up to 10mg)
	***Not always effective		***Not always effective
	*Bradycardia		*[[Bradycardia]]
	**Atropine		**[[Atropine]]
	*Hypotension		*[[Hypotension]]
	**IVF		**[[IVF]]

			==Disposition==

	==References==		==References==