The study aims to highlight the potentially serious consequences of inadvertent soft-tissue injection of intrathecal drugs such as clonidine, during refills of implanted drug delivery devices, and to suggest strategies to reduce this complication. Under some circumstances, large doses of other intrathecal drugs such as bupivacaine, opioids, ziconotide, and baclofen may also be delivered by inadvertent soft-tissue injection with potentially life-threatening consequences. The risks of inadvertent soft-tissue injection of intrathecal drugs during implanted drug delivery device refills and management of such events is poorly documented in the literature. Inadvertent soft-tissue injection is possibly an underappreciated and underreported complication of intrathecal analgesia via an implanted drug delivery device. We report the case of a 51-year-old female with chronic arm pain who sustained a massive clonidine overdose (18,000 mcg) due to inadvertent soft-tissue injection during a refill of an implanted drug delivery device, resulting in rapid loss of consciousness and significant cardiovascular instability requiring urgent resuscitation, subsequent myocardial infarction, cardiac failure, and other significant complications. We recommend that practitioners, institutions, and professional bodies who manage patients with intrathecal analgesia via intrathecal drug delivery devices highlight and audit this complication and develop systems to manage it. A 51-year-old female (66 kg, 157 cm) with a 10-year history of complex regional pain syndrome (CRPS) type I of the right arm underwent routine refilling of an abdominal wall (subcutaneous) implanted drug delivery device (IDDD) (Synchromed EL® Model 8627; Medtronic, Minneapolis, MN, USA: 18-m L reservoir) by a medical practitioner at a remote, local hospital. The IDDD was refilled with clonidine 18,000 mcg (1,000 mcg/m L) and morphine 90 mg (5 mg/m L) in 18 m L of 0.9% saline for intrathecal (IT) analgesia, programmed to deliver 0.2 m L per day (clonidine 200 mcg/morphine 1 mg). The practitioner had performed the refill procedure on numerous occasions and reportedly used the manufacturer's “refill kit” equipment. At therapeutic doses (0.2-0.9 mg/d), clonidine is commonly associated with adverse effects such as dry mouth, sedation, dizziness, and constipation. While generally safe, at toxic doses clonidine can cause serious cardiopulmonary instability and central nervous system (CNS) depression in children and adults. Clonidine is available in a weekly transdermal patch (Catapres TTS: 0.1 mg, 0.2 mg, or 0.3 mg/d, with each patch containing 2.5 mg, 5 mg, and 7.5 mg of clonidine, respectively) and in tablet form (Catapres: 0.1 mg, 0.2 mg, and 0.3 mg; Combipres includes 15 mg of chlorthalidone diuretic). An ophthalmic solution is occasionally used in the treatment of glaucoma. Clonidine is an imidazole derivative and was first used as a nasal decongestant. Decongestants containing tetrahydrozoline, also an imidazole derivative, can result in the same signs and symptoms as clonidine poisoning when ingested, especially in children. Clonidine acts primarily as a presynaptic CNS alpha2-agonist, stimulating receptors in the nucleus tractus solitarii of the medulla oblongata. Sertraline death Amoxicillin uti An overdose with clonidine may cause decreased reflexes, shallow breathing, or irritability. This article on the eMedTV site provides a list of other overdose effects. Three patients who were receiving long-term treatment with intrathecal clonidine experienced a clonidine overdose because. antidote for clonidine overdose. Aug 28, 2018. The use of naloxone for the reversal of clonidine toxicity has been long. a treatment for clonidine overdose.9 Clonidine mediated hypotension. Clonidine poisoning usually causes depressed sensorium, hypotension, and bradycardia. Some patients manifest respiratory depression and miosis simulating narcotic overdose. Supportive care with judicious administration of intravenous fluids, occasionally supplemented by a dopamine infusion, usually reestablished adequate blood pressure. Tolazoline, an alpha-blocker, may reverse clonidine's effects should other efforts fail. Atropine should be used if bradycardia is hemodynamically significant. With massive overdose, clonidine's partial alpha-agonist properties may predominate, resulting in marked hypertension requiring cautious therapy. The experience at Parkland Memorial Hospital with clonidine overdose in six patients demonstrates the myriad of clinical presentations possible. XR) is a prescription medication that belongs to a class of drugs known as alpha-2 adrenergic agonists. As with most medications, it is possible to take too much clonidine. The specific effects of a clonidine overdose can be dangerous but will vary, depending on a number of factors, including the clonidine dosage and whether it was taken with any other medications or substances. If the overdose was recent, a healthcare provider may give certain medicines or place a tube into the stomach to "pump the stomach." In general, vomiting should not be induced. Cupertino, CA: Next Wave Pharmaceuticals, Inc.;2010 November. Cupertino, CA: Next Wave Pharmaceuticals, Inc.;2010 November. Spring Valley, NY: Par Pharmaceutical Companies, Inc.;2008 November. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.;2009 November. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.;2009 October. Newport, KY: Xanodyne pharmaceuticals, inc.; 2006 February. This site does not dispense medical advice or advice of any kind. Treatment will also involve supportive care, such as: Kapvay [package insert]. Site users seeking medical advice about their specific situation should consult with their own physician. Click In order for us to create your customized Health Savvy programs, we need a little more information about the health topic(s) that you are interested in. Press "Continue" button below to begin selecting your Health Savvy topic(s). Remember, you need at least one selected topic to use Health Savvy. If you choose this option, it cannot be undone, and you'll need to choose at least new topic to continue using your Health Savvy programs. Clonidine overdose antidote Yohimbine as an antidote for clonidine overdose - The American., Clonidine Toxicity - Medscape Arimidex vs clomid vs novaldexDoxycycline spectrumValacyclovir 500 mg dailyBuy kamagra online reviewWhere do u buy clomid To the Editor.— We would like to report the use of naloxone Narcan in the reversal of coma and apnea in a child who had ingested an unknown quantity of clonidine Catapres. Report of a Case.— A 16-month-old, 9-kg girl was found by her mother with an open bottle of clonidine. Naloxone for Treatment of Clonidine Overdose JAMA JAMA Network. Tox and Hound - Narcan't - EMCrit. Naloxone reversal of clonidine toxicity dose, dose, dose Clinical.. The pharmacology and pharmacokinetics of clonidine and the symptoms and treatment of acute clinidine overdosage are reviewed. Clonidine, a relatively safe. Jan 20, 2017. Context There are limited reports of adult clonidine overdose. We aimed to describe the clinical effects and treatment of clonidine overdose in. Mar 26, 2018. 10-6-14 Is 'Up to date' a good resource for treatment recommendations in overdose patients? 09-15-14 How does naloxone work to reverse the.