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KEY FEATURES

  • Sympatholytic antihypertensives are central alpha-2-adrenergic agonists

    • Clonidine

    • Guanabenz

    • Guanfacine

    • Methyldopa

  • Symptoms usually resolve in 24 hours

  • Death is rare

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

    • Oxymetazoline

    • Tetrahydrozoline

    • Naphazoline

    • Brimonidine

    • Apraclonidine

    • Tizanidine

    • Xylazine

CLINICAL FINDINGS

  • Bradycardia

  • Hypotension

  • Miosis

  • Respiratory depression

  • Coma

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

DIAGNOSIS

  • Clinical

TREATMENT

  • 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

  • Symptomatic treatment is usually sufficient

    • Maintain blood pressure with intravenous fluids

    • Dopamine can also be used for hypotension

    • Atropine is usually effective for bradycardia

  • Naloxone is reported to reverse symptoms and signs in anecdotal cases and retrospective studies

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