Effects of a Clonidine Taper on Dexmedetomidine Use and Withdrawal in Adult Critically Ill Patients-A Pilot Study

Krupa Bhatt; Ashley Thompson Quan; Laura Baumgartner; Shawn Jia; Rhiannon Croci; Kathleen Puntillo; James Ramsay; Rima H Bouajram

doi:10.1097/CCE.0000000000000245

Effects of a Clonidine Taper on Dexmedetomidine Use and Withdrawal in Adult Critically Ill Patients-A Pilot Study

Crit Care Explor. 2020 Nov 3;2(11):e0245. doi: 10.1097/CCE.0000000000000245. eCollection 2020 Nov.

Authors

Krupa Bhatt¹, Ashley Thompson Quan², Laura Baumgartner³, Shawn Jia⁴, Rhiannon Croci², Kathleen Puntillo², James Ramsay², Rima H Bouajram²

Affiliations

¹ Department of Pharmacy, Scripps Memorial Hospital La Jolla, La Jolla, CA.
² Department of Pharmaceutical Services, University of California, San Francisco Medical Center, San Francisco, CA.
³ Department of Clinical Pharmacy, Touro University California College of Pharmacy, Vallejo, CA.
⁴ Department of Anesthesiology, University of North Carolina, Chapel Hill, NC.

Abstract

Objectives: Prolonged use of dexmedetomidine has become increasingly common due to its favorable sedative and anxiolytic properties. Hypersympathetic withdrawal symptoms have been reported with abrupt discontinuation of prolonged dexmedetomidine infusions. Clonidine has been used to transition patients off dexmedetomidine infusions for ICU sedation. The objective of this study was to compare the occurrence of dexmedetomidine withdrawal symptoms in ICU patients transitioning to a clonidine taper versus those weaned off dexmedetomidine alone after prolonged dexmedetomidine infusion.

Design: This was a single-center, prospective, double cohort observational study conducted from November 2017 to December 2018.

Setting: Medical-surgical, cardiothoracic, and neurosurgical ICUs in a tertiary care hospital.

Patients: We included adult ICU patients being weaned off dexmedetomidine after receiving continuous infusions for at least 3 days.

Interventions: Patients were either weaned off dexmedetomidine alone or with a clonidine taper at the discretion of the providers.

Measurements and main results: The primary outcome was the incidence of at least two dexmedetomidine withdrawal symptoms during a single assessment within 24 hours of dexmedetomidine discontinuation. Time on dexmedetomidine after wean initiation and difference in medication cost were also evaluated. Forty-two patients were included in this study: 15 received clonidine (Group C) and 27 weaned off dexmedetomidine alone (Group D). There was no significant difference in the incidence of two or more withdrawal symptoms between groups (73% in Group C vs 59% in Group D; p = 0.51). Patients in Group C spent less time on dexmedetomidine after wean initiation compared with patients in Group D (19 vs 42 hr; p = 0.02). An average cost savings of $1,553.47 per patient who received clonidine was observed. No adverse effects were noted.

Conclusions: Our study demonstrated that patients receiving clonidine were able to wean off dexmedetomidine more rapidly, with a considerable cost savings and no difference in dexmedetomidine withdrawal symptoms, compared with patients weaned off dexmedetomidine alone. Clonidine may be a safe, effective, and practical option to transition patients off prolonged dexmedetomidine infusions.

Keywords: adrenergic alpha-2 receptor agonists; clonidine; dexmedetomidine; hypnotics and sedatives; substance withdrawal syndrome; symptom assessment.