Evaluating the Transition From Dexmedetomidine to Clonidine for the Prevention of Withdrawal in Critically Ill Pediatric Patients.

Objectives: To evaluate clonidine for preventing withdrawal from dexmedetomidine infusions and describe the incidence of withdrawal symptoms and adverse cardiovascular effects in critically ill pediatric patients.

Methods: Retrospective, descriptive study of patients in Advocate Children's Hospital-Park Ridge PICU who received dexmedetomidine infusion for ≥72 hours, followed by clonidine for ≥48 hours, between January 1, 2015, and August 31, 2017.

Results: Thirty-eight patients (median age 4.3 years; IQR, 2-11.5) received 39 dexmedetomidine courses. The median duration of dexmedetomidine exposure was 7.6 days (IQR, 5-11.5) at an average dose of 1 mcg/kg/hr. The median dose of clonidine at initiation was 8.3 mcg/kg/day (for <50 kg) and 4.1 mcg/kg/day (for ≥50 kg). The most common oral administration frequency was every 8 hours. Dexmedetomidine infusions for 7 days or longer and a higher dexmedetomidine dose 24 hours prior to clonidine transition both correlated with increased initial clonidine doses. Fourteen patients (37%) had at least 1 WAT-1 score of ≥3 during the transition between dexmedetomidine and clonidine, with 7 (18%) requiring an increase in sedation. Adverse cardiovascular events were possibly attributable to dexmedetomidine and/or clonidine in 4 patients.

Conclusions: Patients receiving prolonged infusions of dexmedetomidine may transition to clonidine to help prevent withdrawal symptoms. Duration of dexmedetomidine infusion of 7 days or longer and higher average dexmedetomidine dose 24 hours prior to the transition are important considerations when determining the initial clonidine dose. Transition from dexmedetomidine to clonidine was found to be safe and efficacious in our patients, with minimal adverse effects.