Clonidine Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

Most often in UHG clonidine has been commenced in critical care. When the patient is being transferred FROM critical care, a plan must be documented as to how this is to be weaned.
As far as possible, the patient should be changed to oral therapy (same equivalent dose)
Do not discontinue clonidine abruptly. To avoid rebound hypertension, gradually reduce dose over 2 to 3 days (ref 1)
For Y-site compatibility see below

Available preparations

Catapres 150 micrograms per 1ml ampoule

Reconstitution

Already in solution

Draw up using a 5 micron filter needle

Infusion fluids

Sodium chloride 0.9%

Glucose 5%

Methods of intravenous administration

Slow intravenous injection (hypertensive crises)

Administer required dose over 10 to 15 minutes (see under further information regarding rate)
It may be preferable to add to a small volume of infusion fluid and give as a short infusion because a slow IV injection over 10 to 15 minutes is probably not practical ^{(ref 2)}

Intermittent intravenous infusion (administer using an electronically controlled infusion device) ^{(ref 3)}

Add required dose to 100ml infusion fluid and administer over 15 minutes
A 50ml infusion may be used if required (eg fluid restriction) but the residual volume in the infusion line must be flushed through at the same rate to avoid significant underdosing

Dose in adults

Hypertensive crises

Give 150 to 300 micrograms by slow intravenous injection
This dose may be repeated up to a maximum of 750 micrograms in a 24 hour period

Sedation in the ICU setting (unlicensed) ^{(ref 3)}

Give 25 to 150 micrograms every six to eight hours

Monitoring

Monitor blood pressure and heart rate while patient is on clonidine
- Monitor every 5 minutes while the infusion is running, and every 10 minutes after that for another 30 minutes ^{(ref 4)}
When discontinuing clonidine, monitor blood pressure (to ensure rebound hypertension does not occur), and also monitor for sedation
Avoid sudden withdrawal as this can cause a hypertensive crisis ^{(ref 1)}
If blood pressure or heart rate drops, then the dose rather than the frequency should be reduced ^{(ref 3)}

Further information

Giving clonidine over 10 to 15 minutes may avoid a possible transient pressor effect
Renal impairment: monitor closely as antihypertensive effect may show high variability

Storage

Store at room temperature less than 25⁰C

References

Catapres SPC August 2017

1 Uptodate accessed online 09/12/2021

2. Injectable drug guide, accessed via Medicinescomplete 09/12/2021

3: Critical Illness accessed via Medicinescomplete 09/12/2021

4: Local specialist recommendation- Dr O. FInnerty, email on file

Therapeutic classification

Antihypertensive but also used in pain and addiction management in critical care

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