Q: 54 year old female is admitted to ICU with clonidine overdose. Patient appears very sedated. You are trying to avoid intubation. Which of the following drug may be use to reverse clonidine effect and may prevent intubation?

A) Flumazinil
B) Naloxone
C) Dexmedetomidine
D) Lopressor
E) Hemo-dialysis (HD)


Answer: B

Clonidine toxicity can be reversed with 1 to 2 mg x 1 dose of Naloxone, particularly in patients with CNS and respiratory depression. Interestingly, majority of patients who respond to naloxone do not require additional doses. If patient do not respond to x 1 attempt to Naloxone, further administration of Naloxone should be avoided and supportive care should be instituted till patient stabilized. And, if patient respond to Naloxone but symptoms recur later, intermittent doses can be used upto maximum of 10 mg. Continuous infusion should be preferably be avoided.

Flumazinil has no role in this situation
Dexmedetomidine and Lopressor may make symptoms worse, and
HD does not remove clonidine

Reference: 

1. Wiley JF 2nd, Wiley CC, Torrey SB, Henretig FM. Clonidine poisoning in young children. J Pediatr 1990; 116:654.

2. Spiller HA, Klein-Schwartz W, Colvin JM, et al. Toxic clonidine ingestion in children. J Pediatr 2005; 146:263.