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Clonidine exposures in children under 6 (2004–2017): a retrospective study
  1. Rose Cairns1,2,3,
  2. Jared A Brown1,
  3. Nicholas A Buckley1,2
  1. 1New South Wales Poisons Information Centre, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  2. 2Pharmacology, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
  3. 3Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Rose Cairns, New South Wales Poisons Information Centre, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; rose.cairns{at}health.nsw.gov.au

Abstract

Objective To describe trends in clonidine exposures in children under 6. Clonidine has become increasingly popular for management of paediatric behavioural disorders. Clonidine has a narrow therapeutic index, and toxicity can occur with inadvertent double dosing. Clonidine is not recommended for use in children under 6 years.

Design and setting A retrospective review of clonidine exposures in children under 6 reported to the New South Wales Poisons Information Centre (NSWPIC, Australia’s largest poison centre), 2004–2017. This was compared with community clonidine utilisation using dispensing data from Australian Statistics on Medicines, 2004–2015. Australian trends were compared with clonidine exposure calls to US poison centres, 2006–2016.

Main outcome measures Trends in poisonings and dispensing; demographics, dose, exposure type, clonidine source, symptoms, disposition.

Results There were 802 clonidine exposures in the NSWPIC database, increasing 4.9% per year, 2004–2017 (95% CI 3.1% to 6.7%, p<0.001), correlated with increased dispensing, r=0.846 (95% CI 0.529 to 0.956, p<0.001). 78.6% were hospitalised and medical toxicologists were consulted in 7.2%, indicating high risk and/or morbidity. Clonidine was prescribed for the patient in at least 27.8%, providing evidence for prescribing outside of recommendations. US data reveals 19 056 clonidine exposures, with 3.7% increase per year, 2006–2016 (95% CI 2.2% to 5.3%, p<0.001).

Conclusions Clonidine exposures in children under 6 are increasing, and this trend is not isolated to Australia. Exposures have a high hospital referral rate and high morbidity. Caution should be exercised when prescribing clonidine, and parent/carer education is important for safe storage and increased vigilance when dosing.

  • toxicology
  • injury prevention
  • pharmacology

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Footnotes

  • Contributors RC conceptualised and designed the study, extracted and analysed the data, drafted the initial manuscript, and reviewed and revised the manuscript. JAB conceptualised and designed the study, supervised data extraction and coding, and reviewed and revised the manuscript. NAB conceptualised and designed the study, supervised data analysis, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This project was supported by a National Health and Medical Research Council (NHMRC) Program Grant (1055176).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Sydney Children’s Hospitals Network Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The New South Wales poisons centre data are unable to be shared due to privacy concerns. PBS and US poison control data used are freely available.

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