CLONIDINE

Formulary status AMBER 2 Initiation by a specialist followed by maintenance in primary care (oral preparations).

Formulary status   RED  Specialist or hospital prescribing only (patches and IV preparations).

Preparations

TABLETS 25microgram and 100microgram.

LIQUID 10microgram in 1ml (GSTT Special).

INJECTION 150microgram in 1ml. 

PATCHES 7.5mg (300microgram / day)

RTA (Ready-to-Administer) Standard Concentration Prefilled Syringes (PFS)

​BATCH Manufacturing

RTA PFS 150 microgram in 20mL Sodium Chloride 0.9% (7.5mcg/mL)

RTA PFS 750 microgram in 50mL Sodium Chloride 0.9% (15mcg/mL)

RTA PFS 2,000 microgram in 50mL Sodium Chloride 0.9% (40mcg/mL)

Dosage

ATTENTION DEFICIT HYPERACTIVITY DISORDER WITH OR WITHOUT OPPOSITIONALITY, OR WITH TIC DISORDER, TOURETTES SYNDROME

These are unlicensed indications.

Orally, initially, 25microgram at night for 1-2 weeks then increase to 50microgram at night.

If required dose can be further increased by 25microgram every 2 weeks, side effects permitting.

Maximum dose 5microgram/kg/day (or up to a maximum of 300microgram/day).


DYSTONIA

These are unlicenced indications.

Orally, initially, 3microgram/kg three times daily. Doses may be escalated rapidly.

In the inpatient setting (BP and respiratory monitoring) doses may be escalated up to the equivalence of 2microgram/kg/hour IV. Under the supervision of the consultant neurologists doses may be increased up to 5microgram/kg/hour.

Doses up to 8 microgram/kg/hour have been tried for status dystonicus. Doses >5microgram/kg/hour must be given on PICU.

Continuous IV infusions or Clonidine patches may be considered (at 1;1 dose conversions) for children unable to take orally or on high doses.

Link to guidance on switching from oral/enteral/IV clonidine to patches (internal intranet only) http://tww-wafr/WAFR-FAD/Applications/ClinicalGuidance/User/Details.aspx?id=7391


SEDATION/PAIN/OPIATE WITHDRAWAL

Orally, initially, 3micrograms/kg three times daily (increase if necessary to 5microgram/kg/dose). Above 50kg initial dose should be 50 microgrammes 8 hourly and then titrate up if tolerated and required

Link to PICU guideline (internal intranet only)http://tww-wafr/WAFR-FAD/Applications/ClinicalGuidance/User/Details.aspx?id=3844

IV Infusion, (PICU/HDU only),

Commence infusion at 1 micrograms/kg/hour.

If required increase by 0.5microgram/kg/hour until adequate sedation is achieved.  Max 2micrograms/kg/hour. 

Weaning (Oral/IV):

Clonidine can be stopped immediately if used for <2 weeks.

If used for >2 weeks reduce daily over 5 days (e.g. 5, 4, 3, 2, 1microgram/kg/dose 3 times a day) then stop.

DIAGNOSIS OF GROWTH HORMONE DEFICIENCY

This is an unlicensed indication.

Children over 3 years0.15mg/m2(SEE SEPARATE PROTOCOL).

Administration

Link to Paediatric Medusa

Clonidine may be diluted in sodium chloride 0.9% or glucose 5%.

Clonidine must not be bolused or double pumped.

IV Infusion as Standard Concentrations

(to be used in Combination with  "smart" infusion pumps)

PICU and Theatres

< 5kg             150microgram in 20mL Sodium Chloride 0.9%(7.5mcg/ml)

5-20kg       750microgram in 50mL Sodium Chloride 0.9% (15mcg/mL)

> 20kg          2,000 microgram in 50mL Sodium Chloride 0.9% (40mcg/mL)

IV Infusions using VARIABLE concentrations (weight based) Please see "Administration of Medicines to Children" section "Prescribing in Children"

Notes

  1. Blood pressure and pulse must be monitored on initiating treatment and after each dosage increase.  Patients on concomitant methylphenidate should have a base line and then three monthly ECGs.
  2. The 100microgram tablets can be crushed and dispersed in water.
  3. Patches should be placed on the abdomen and sites rotated. Patches deliver an even dose over a week. Initial delivery takes 2-3 days to reach full dose delivery.


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Last Published on Tuesday, March 24, 2020 11:44:39 AM