Recent Literature on Clonidine in Children and Adolescents
Recent Literature on Clonidine in Children and Adolescents
Clonidine has become a standard part of the management of pain, anxiety, and paroxysmal autonomic instability with dystonia (PAID) in children and adolescents with acquired brain injury. The symptoms of PAID, intermittent agitation, fever, hypertension, sinus tachycardia, dystonic movements, and diaphoresis, are often difficult to control and frequently require a combination of drugs. Traditional therapy has consisted of morphine, a beta-adrenergic blocking agent (propranolol, metoprolol, or labetalol), a benzodiazepine and/or baclofen to reduce muscle tone. The addition of clonidine or dexmedetomidine provides additional benefit in controlling both cardiovascular and CNS symptoms.
While PAID is most often associated with traumatic brain injury, it may occur after stroke, anoxic injury, or infection. Safadieh and colleagues recently described the management of PAID in a 7-month-old with Streptococcus pneumoniaemeningitis who subsequently was found to have basal ganglia and hypothalamic infarctions. Within weeks of diagnosis, the patient began to experience daily periods of agitation, hypertension, tachycardia, tachypnea, hyperthermia, and diaphoresis suggesting the development of PAID. Lorazepam and baclofen were started, as well as clonidine (3 mcg/kg given twice daily). The dose was slowly titrated to a final dose of 5 mcg/kg given four times daily. Symptoms were controlled until 8 weeks after admission when the patient developed hydrocephalus. The patient improved after receiving a ventriculoperitoneal shunt and clonidine was later successfully weaned off.
Paroxysmal Autonomic Instability With Dystonia
Clonidine has become a standard part of the management of pain, anxiety, and paroxysmal autonomic instability with dystonia (PAID) in children and adolescents with acquired brain injury. The symptoms of PAID, intermittent agitation, fever, hypertension, sinus tachycardia, dystonic movements, and diaphoresis, are often difficult to control and frequently require a combination of drugs. Traditional therapy has consisted of morphine, a beta-adrenergic blocking agent (propranolol, metoprolol, or labetalol), a benzodiazepine and/or baclofen to reduce muscle tone. The addition of clonidine or dexmedetomidine provides additional benefit in controlling both cardiovascular and CNS symptoms.
While PAID is most often associated with traumatic brain injury, it may occur after stroke, anoxic injury, or infection. Safadieh and colleagues recently described the management of PAID in a 7-month-old with Streptococcus pneumoniaemeningitis who subsequently was found to have basal ganglia and hypothalamic infarctions. Within weeks of diagnosis, the patient began to experience daily periods of agitation, hypertension, tachycardia, tachypnea, hyperthermia, and diaphoresis suggesting the development of PAID. Lorazepam and baclofen were started, as well as clonidine (3 mcg/kg given twice daily). The dose was slowly titrated to a final dose of 5 mcg/kg given four times daily. Symptoms were controlled until 8 weeks after admission when the patient developed hydrocephalus. The patient improved after receiving a ventriculoperitoneal shunt and clonidine was later successfully weaned off.
Source...