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The use of Clonidine outside its licensed indication in paediatric psychopharmacology: a UK survey of current practice
  1. RL MacLeod,
  2. DV Keen
  1. Department of Developmental Paediatrics, St George's Healthcare NHS Trust, London, UK

Abstract

Aims To ascertain current practice, experience and opinion among UK clinicians of the use of Clonidine for the treatment of conditions such as tics and behavioural disturbances, with particular focus on sleep problems.

Methods Electronic survey sent to all Child and Adolescent Psychiatrists (CAPs) and Paediatricians in selected specialties. 389 respondents (116 Paediatricians, 273 CAPs).

Results 172 (44%) respondents prescribed Clonidine in the last year, most commonly for (in decreasing order of frequency) tic disorders, sleep problems, hyperactivity and aggression. CAPs were more likely to prescribe for hyperactivity; Paediatricians for sleep problems.

Patient numbers ranged from 0-100 with Paediatricians having the largest caseloads.

Over 90% practised in line with NICE attention deficit hyperactivity disorder (ADHD) guidelines regarding initial physical/cardiovascular examination, but not in the use of electrocardiograms. After initiation, 78% monitored blood pressure.

The majority reported a good level of short-term effectiveness in tics, sleep and hyperactivity, but some reduction in effect in long-term use, especially for sleep. 59% experienced drug tolerance which had an impact on ultimate efficacy. Adverse effects, reported by 54%, were generally considered mild.

53 respondents (31%) prescribed for a range of sleep problems including movement disorders, for children aged 2-18 years, predominately with neurodevelopmental disorders. 94% reported using drugs as second line treatment.

Initiation dose, titration regime and maximum doses showed considerable variation but within the broad parameters described in the literature.

In general, there were no significant differences in practice evident between Paediatricians and CAPs.

272 respondents had not prescribed Clonidine, not managing relevant conditions, not knowing how to use it or because of concerns about safety or effectiveness. Despite this, 92% of all respondents said they would find clinical guidelines helpful for their practice.

Conclusion There is a lack of rigorous evidence for tics and behaviour and only anecdotal evidence for sleep.

This survey suggests:

  1. The use of Clonidine by both professions is mostly appropriate, albeit on the basis of limited evidence.

  2. A lack of knowledge about a potentially useful drug for which clinical guidelines would be helpful.

  3. A need for properly constructed, large scale, randomised controlled trials for Clonidine, particularly in sleep disorders.

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