Download Transdermal Clonidine

Transdermal Clonidine - paediatrics
For use in PICU and Ward 23B
Indications
Dose & Prescription

To provide analgesia and sedation post cardiac surgery.

To control hypertension.

As an adjunct in weaning patients who are withdrawing from
opiates and/or benzodiazepines.
Dose

Clonidine can be given orally, intravenously, or by
transdermal patch. This guideline only covers transdermal
use – for information on clonidine dosing via other routes
please refer to the Royal Children’s Hospital Pharmacopeia
via Reference viewer

Transdermal patches are preferred as they release a
controlled amount continuously for a week.

Clonidine transdermal patches should only be initiated by
PICU medical personal, anaesthetics or by the pain service
Dosing for Clonidine transdermal patches
[Note that there is no published data on transdermal dosing in
infants and young children. The doses below are based on
current practice which is extrapolated from IV and oral dosing.]
For children under 8 Kg:
 Clonidine transdermal patches are not to be used
outside of the PICU setting for patients less than 8kg.
They can be used in PICU at the discretion of the
PICU consultant.
 If used for patients < 8 kg the cloninide patch is to be
removed at discharge from PICU and is not to be recharted on the ward drug chart.
For children greater than 8 Kg
 Maximum daily dose is between 15-18 mcg/kg/day
 Patients 8-20 kg use a TTS1 patch
 Patients >20kg use a TTS2 patch
 Can grade up after 1-2 weeks to the next dose size if
required (this will be very unlikely in the ward situation)
Service: Paediatric Cardiology
Date last updated: September 2013
To be reviewed: September 2014
Author(s): Marion Hamer, David Buckley, Liz Oliphant
Please note: The electronic version of these guidelines is the version currently in use.
Any printed copy cannot be assumed to be current. www.adhb.govt.nz
Page 1 of 4
Transdermal Clonidine - paediatrics
For use in PICU and Ward 23B
Prescription

To be charted on the ward medication chart with a date and
time noted when applied in PICU.

The ward medical staff will not initiate a clonidine patch in the
ward setting.
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Administration




Apply to dry hairless skin on the upper arm or chest. If
replacing apply at a new site
Be very careful not to damage the under side membrane
during application.
Patches are supplied with an optional extra adhesive backing.
It is not necessary to apply this unless the patch begins to
peel off during the week. However, care must be taken to
ensure the active medicated side of the patch is applied,
rather than the non-medicated backing adhesive.
The patches all last for 7 days and come in 3 different doses TTS1, TTS2, and TTS3
-
TTS1 releases 100mcg/day clonidine
TTS2 releases 200mcg/day clonidine
TTS3 releases 300mcg/day clonidine

In virtually all cases, patches will already have been
applied while the patient is in PICU.

Clonidine patches should be discontinued once the child is
comfortable with minimal other analgesia (paracetamol +/NSAIDs). For most children, this is likely to be around day 3-4
postoperatively. Patches should be removed earlier if adverse
reactions occur.
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Observation &
Documentation
1. Document heart rate and blood pressure at least 4 hourly, or
as specified by the prescriber
2. Document sedation level at least 4 hourly
3. Observe skin site daily for irritation
4. Monitor for adverse reactions
Service: Paediatric Cardiology
Date last updated: September 2013
To be reviewed: September 2014
Author(s): Marion Hamer, David Buckley, Liz Oliphant
Please note: The electronic version of these guidelines is the version currently in use.
Any printed copy cannot be assumed to be current. www.adhb.govt.nz
Page 2 of 4
Transdermal Clonidine - paediatrics
For use in PICU and Ward 23B
5. Discontinue by removing patch but remember it will take a
number of hours for effects to dissipate
6. Monitor for symptoms of excessive dose

Manifestations of excessive dose are
due to
generalised sympathetic depression

These include pupillary constriction, lethargy,
bradycardia, hypotension, somnolence (coma in severe
cases), and respiratory depression (including apnoea).

Paradoxic hypertension caused by stimulation of
peripheral alpha1-receptors may occur rarely.
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Contraindications &
Precautions
Contraindications
1. Heart block or severe bradyarrhythmia
2. Hypotension (use with caution in combination with other
antihypertensives)
3. Overly sedated patient
Precautions
1.
2.
3.
4.
Hypovolaemia – makes hypotension more likely
Bradycardia – can exacerbate this
Renal failure – avoid or reduce dose
Constipation – can exacerbate this
Drug interactions
1. The hypotensive effects of other antihypertensive
medications (diuretics, vasodilators, beta- receptor
blockers, calcium antagonists or ACE-inhibitors) may be
potentiated by the addition of clonidine
2. Concomitant administration of other medications which
can slow heart rate (e.g. beta blockers or digoxin) can
cause or potentiate bradycardic rhythm disturbances.
For detailed information about this drug including clinical
pharmacology, please see Medsafe data sheet for Clonidine in
Reference viewer
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Possible adverse
effects


Excessive sedation
Dry mouth/eyes
Service: Paediatric Cardiology
Date last updated: September 2013
To be reviewed: September 2014
Author(s): Marion Hamer, David Buckley, Liz Oliphant
Please note: The electronic version of these guidelines is the version currently in use.
Any printed copy cannot be assumed to be current. www.adhb.govt.nz
Page 3 of 4
Transdermal Clonidine - paediatrics
For use in PICU and Ward 23B



Hypotension
Rash / Itch
Skin irritation at site of patch
This list is not exhaustive, for detailed information about this drug
including side effects, please see Medsafe data sheet for Clonidine
in Reference viewer
Special
considerations
References

Clonidine patches contain aluminium, and should be removed
prior to MRI to prevent skin burns, or before defibrillation or
cardioversion as the alteration in electrical conductivity may
increase the risk of arcing.

Handover between staff is important: discussion with medical
staff needs to take place at both morning and evening
handover and also between nursing staff at each shift
change.

In the event of excessive sedation, bradycardia, or
hypotension remove the patch and notify medical staff.
1. Brunton LL, Chabner BA, Knollmann BC, editors. Goodman
and Gillman’s The Pharmacological Basis of Therapeutics.
12th edition. New York: McGraw-Hill; 2010
2. Kemp A, McDowell JM, editors. Paediatric Pharmacopoeia.
13th edition. Melbourne: Pharmacy Dept Royal Children’s
Hospital; 2002
3. Shann, F. Drug doses. 14th edition. Melbourne: Royal
Children’s Hospital; 2010
4. Catapress TTS [data sheet online]. Boehringer Ingelheim
(N.Z.) Limited [updated 8/10/2010]. Available from URL:
http://www.medsafe.govt.nz
Service: Paediatric Cardiology
Date last updated: September 2013
To be reviewed: September 2014
Author(s): Marion Hamer, David Buckley, Liz Oliphant
Please note: The electronic version of these guidelines is the version currently in use.
Any printed copy cannot be assumed to be current. www.adhb.govt.nz
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