Clonidine toxicity

Q: The preferred method of counteracting clonidine overdose/toxicity is? (select one)

A) Naloxone 

B) Yohimbine

C) Hemodialysis

Answer: A

There is no specific antidote for clonidine. Supportive care and other basic management like gastrointestinal decontamination still stay as the mainstay of therapy.

Naloxone has been reported to reverse some of the effects of clonidine or related imidazoline, particularly central nervous system (CNS), and to some extent respiratory depression without causing rebound hypertension. There have been some reports of using alpha-adrenergic antagonists such as tolazoline and yohimbine, but due to the risk of associated hypotension, its use is not recommended.

Clonidine does not get removed by hemodialysis.

#toxicology

References:

1. Seger DL, Loden JK. Naloxone reversal of clonidine toxicity: dose, dose, dose. Clin Toxicol (Phila) 2018; 56:873.

2. Isbister GK, Heppell SP, Page CB, Ryan NM. Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity. Clin Toxicol (Phila) 2017; 55:187.

3. Roberge RJ, McGuire SP, Krenzelok EP. Yohimbine as an antidote for clonidine overdose. Am J Emerg Med 1996; 14:678.