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Key Features

  • Symptoms usually resolve in 24 hours

  • Deaths are rare

  • Similar symptoms may occur after application of topical nasal decongestants chemically similar to clonidine; for example

    • Oxymetazoline

    • Tetrahydrozoline

    • Naphazoline

    • Brimonidine

    • Apraclonidine

    • Tizanidine

Clinical Findings

  • Bradycardia

  • Hypotension

  • Miosis

  • Respiratory depression

  • Coma

  • Transient hypertension occasionally occurs as a result of peripheral α-adrenergic effects

Diagnosis

  • Clinical

  • Not detected in usual toxicology screenings

Treatment

  • Symptomatic treatment is usually sufficient

    • Maintain blood pressure with intravenous fluids

    • Dopamine can also be used for hypotension

    • Atropine is usually effective for bradycardia

  • Activated charcoal

    • Administer 60–100 g orally or via gastric tube, mixed in aqueous slurry

    • Do not use for comatose or convulsing patients unless it can be given by gastric tube and the airway is protected by a cuffed endotracheal tube

  • There is no specific antidote

    • Tolazoline should not be used for clonidine overdose because its effects are unpredictable

    • Naloxone has had anecdotal success

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