Title: Sometimes more is better: naloxone and clonidine toxicity.<br/>Author: Hong Kim<br/><a href='http://umem.org/profiles/faculty/526/'>[Click to email author]</a><hr/><p> Clonidine, (central alpha-2 receptor agonist) can produce opioid-like toxidrome in addition to its cardiac effects (bradycardia and hypotension). Previous studies have shown that naloxone has variable (~40%) success in reversing CNS/respiratory depression and cardiac effect.</p> <p> A recent retrospective study (n=51) of pediatric poisoning showed that administration of 5 to 10 mg had improved reversal of clonidine toxicity.</p> <p> Total of 51 somnolent patients: 5- 10 mg of naloxone reversed 40 patients</p> <ul> <li> 22 patients awoke with 6 mg or less</li> <li> Bradycardia reversed in 17 of 44 patients</li> <li> Hypotension reversed in 7 of 11 patients</li> </ul> <p> There was no adverse effect from naloxone administration.</p> <p> Repeat administration of naloxone was required in some patients.</p> <p> <strong>Bottom line</strong></p> <ul> <li> For pediatric clonidine toxicity, consider initial naloxone dose of 5 mg IV. </li> </ul> <fieldset><legend>References</legend>
<p> Seger DL, Loden JK. Naloxone resersal of clonidine toxicity: dose, dose, dose. Clin Toxicol (Phila) 2018 Mar 16:1-7. doi: 10.1080/15563650.2018.1450986. [Epub ahead of print] </p> </fieldset>