Evaluating the transition from dexmedetomidine to clonidine for agitation management in the intensive care unit

OBJECTIVES: Limited literature exists examining the use of enteral clonidine to transition patients from dexmedetomidine for management of agitation. The aim of this study was to evaluate dexmedetomidine discontinuation within 8 h of enteral clonidine administration in addition to the rates of dexmedetomidine re-initiation in patients who failed clonidine transition. METHODS: A single-center, retrospective analysis evaluated critically ill adult patients from 1 February 2013 to 28 February 2014, who used dexmedetomidine and clonidine for sedation management. Patients were excluded if they received enteral clonidine for reasons other than sedation management. Secondary aims of the study observed time to dexmedetomidine discontinuation, agitation (Richmond Agitation Sedation Scale) and delirium ratings (Confusion Assessment Method for the intensive care unit), clonidine dose, and enteral clonidine discontinuation. RESULTS: In all, 26 patients were evaluated. Demographics included a mean age of 54.4 (±16.7) years, Acute Physiology and Chronic Health Evaluation II score of 18 (interquartile range = 14–22), and 80.7% of admissions to the cardiac surgery intensive care unit. Dexmedetomidine discontinuation occurred in 17 (65.4%) patients within 8 h of receiving clonidine. The total median clonidine exposure per intensive care unit day was 0.35 mg/ICU day (interquartile range = 0.2–0.5) in patients who discontinued dexmedetomidine within 8 h and 0.5 mg/ICU day (interquartile range = 0.4–1.0) (p = 0.036) in patients who did not. We observed similar Richmond Agitation Sedation Scale and Confusion Assessment Method for the intensive care unit scores and rates of hypotension. Unintentional use of clonidine beyond ICU and hospital stay was observed in 54% and 23% of patients, respectively. CONCLUSION: Enteral clonidine may be an effective and safe alternative to transition patients off of dexmedetomidine for ongoing sedation management. Clinicians should critically evaluate the need for clonidine at ICU and hospital discharge. More studies comparing the use of clonidine to transition from dexmedetomidine infusions are needed.