Sunday, November 18, 2007

Sunday November 18, 2007
Clonidine in alcohol withdrawal


Relatively unknown but clonidine is a very viable option beside benzodiazepines in ETOH withdrawal symptoms.

Clonidine reverses central adrenergic discharge, relieving tachycardia, hypertension, tachypnea, tremor, and possibly some craving for alcohol. Also in patch form, it provides a part of sedation.

Oral dose of clonidine is 0.1- 0.2 mg tid. It can also be use in IV drip form but with caution (not available in USA as IV).

Please note, though clonidine is very effective in the treatment of alcohol, opiate, nicotine withdrawal syndromes, attention-deficit/hyperactivity disorder (ADHD) and Tourette's syndrome -but does not help if symptoms progress to seizures and hallucinations-delirium tremens.


2 major cautions for ICU physicians:

1. Clonidine itself can cause withdrawal symptoms if discontinued abruptly. It should be slowly decreased over several days to avoid withdrawal symptoms. Withdrawal can cause hypertension, irritability, nervousness, insomnia, and headache.
2. Clonidine dose should be reduced and should be use with caution in patients with chronic renal failure and coronary artery disease.




Trivia: Clonidine was first introduced in 1960s as a nasal decongestant.






Reference: Click to get abstract

1.
Clonidine and alcohol withdrawal - Adv Alcohol Subst Abuse. 1987;7(1):17-28

2.
Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal - JAMA, Vol. 278 No. 2, July 9, 1997

3.
CLONIDINE IN THE TREATMENT OF ALCOHOL WITHDRAWAL IN THE INTENSIVE CARE UNIT- British Journal of Anaesthesia, 1992, Vol. 68, No. 1 106-108

4.
Intrathecal and Oral Clonidine as Prophylaxis for Postoperative Alcohol withdrawal Syndrome: A Randomized Double-Blinded Study - Anesth. Analg., March 1, 2004; 98(3): 738 - 744.