Clonidine poisoning
Clonidine is an imidazoline drug for the treatment of hypertension from the group of α 2 -adrenomimetics. Clonidine, like Gemiton, Katapresan, Capressin, Clonilon, is the proprietary trade name of the active ingredient clonidine.
Source: vetinpharm.com
Clonidine is a centrally acting antihypertensive drug that lowers blood pressure by reducing impulses from the central nervous system, inhibiting the vasomotor center and reducing the concentration of norepinephrine. In addition to the hypotensive, it has a powerful sedative effect.
Clonidine is used in the form of tablets, eye drops, and injection.
After oral administration, the therapeutic effect occurs after 1-2 hours and lasts 6-12 hours, with intravenous administration, the effect manifests itself in 3-5 minutes, reaches a maximum after 15-20 minutes and lasts for 4-8 hours.
The therapeutic dose of the drug when taken orally is 0.3-0.45 mg / day (divided into 2-3 doses), in rare cases the daily dose reaches 1.2-1.5 mg.
Clonidine was most actively used for the treatment of arterial hypertension from the late 70s to the mid 80s of the last century. Its subsequent use was limited due to an extensive list of contraindications and numerous side effects on the part of hemodynamics and the central nervous system: lethargy, slowing down of the reaction rate, drowsiness, depression, decreased heart rate, a sharp decrease, and sometimes a sudden increase in blood pressure (BP).
A serious adverse reaction after intravenous administration of the drug is a short-term sharp jump in blood pressure, preceding the main hypotensive effect. In this regard, it is not recommended to inject clonidine into a vein in the elderly, since neurological or cardiac disorders may develop against the background of a hypertensive phase. With a sharp withdrawal of Clophilin, there is often a deterioration in well-being, a return or intensification of the symptoms of the disease.
Currently, with the availability of new, more effective drugs, Clonidine is rarely used, mainly for the relief of emergency conditions.
The average dose of Clonidine causing poisoning in children is 0.509 mg, in adults - 2.096 mg. A pronounced toxic effect, usually with a lethal outcome, was manifested in children as a result of a single dose of 0.4-4 mg (from 3 to 30 tablets of 0.15 mg, depending on age), in adults - 4.5-11, 25 mg (40-70 tablets of 0.15 mg).
Clonidine is quite aggressive in terms of the degree of pharmacological effect, therefore, if it is incorrectly prescribed and taken, the development of acute intoxication is likely.
How does clonidine poisoning occur?
Poisoning is possible in several cases:
- exceeded dose or independently increased frequency of administration;
- elderly age;
- increased individual sensitivity;
- joint intake with alcohol;
- the use of the drug by the child during the game;
- reception with a suicidal purpose.
Due to the specific interaction of the drug with alcohol (the development of pathological intoxication that does not correspond to the dose taken, a powerful hypnotic effect and the absence of memories of previous events), it is often used in criminal practice as a means of committing crimes.
Poisoning symptoms
The main manifestations of Clonidine poisoning develop from the cardiovascular and nervous system 30-60 minutes after taking the drug. In case of criminal poisoning in combination with alcohol, the symptoms of intoxication are violent, developing within a few minutes.
Psychoneurological disorders in case of poisoning are pronounced:
- constriction of the pupils, sluggish reaction to light;
- the victim is available to contact, but does not show interest in the environment;
- drowsiness, slow reactions or, on the contrary, pronounced agitation;
- decreased muscle tone.
In severe cases:
- depression of consciousness up to coma;
- unsteadiness of gait, impaired coordination of movements;
- clonic-tonic convulsions prone to recurrence;
- depression of the respiratory center, manifested by rare and superficial respiratory movements with periodic episodes of apnea;
- bright hallucinations;
- retrograde amnesia.
A characteristic sign of clonidine poisoning is inhibition of the center of thermoregulation and the development of hypothermia, on average up to 35.8 ° C. Suppression of central nervous system activity is neutralized with specific therapy, usually within 12–36 hours.
Manifestations of acute intoxication from the cardiovascular system:
- decrease in heart rate;
- severe hypotension, often orthostatic in nature, associated with a change in body position (symptom of "Vanka-vstanka");
- paradoxical increase in blood pressure;
- violation of the conduction of excitation through the tissues of the heart;
- in severe cases, the development of atrial or ventricular fibrillation.
Cardiological symptoms in complex treatment are eliminated in the first 24 hours, however, bradycardia can persist for up to 3 days or more.
In addition to specific symptoms, the victims complain of dizziness, headache, visual impairment, dry mouth, and excessive sweating.
Source: depositphotos.com
First aid for poisoning with Clonidine
- Provide complete emotional and physical peace.
- Rinse the stomach (drink 1-1.5 liters of warm water or a light pink solution of potassium permanganate and induce a gag reflex by pressing on the root of the tongue), repeat the procedure until clean rinsing water.
- Carry out detoxification with enterosorbent (Polyphepan, Enterosgel, Polysorb, Atoxil or any other enterosorbent);
- Take a saline laxative (magnesium sulfate).
When is medical attention required?
Medical care for Clonidine poisoning is necessary if:
- first aid measures do not bring relief or the condition worsens;
- a child, elderly person, or pregnant woman is injured;
- there are hallucinations, delusions, the victim is poorly oriented in space and time;
- the victim is in a stupor, soporous or coma;
- convulsive syndrome developed;
- pulse less than 40 beats per minute;
- there is a persistent increase in blood pressure.
Possible consequences
Taking tablet forms of the drug, as a rule, does not lead to death, despite the fact that it can cause severe acute intoxication. Depression of the central nervous system can be complicated by oxygen starvation, impaired cognitive functions. An abrupt increase in blood pressure after intravenous administration can lead to hemorrhagic stroke, myocardial infarction.
In the case of criminal poisoning with Clonidine, the likelihood of coma and death of the victim is high. After the relief of symptoms of intoxication, it is possible to preserve neurological disorders, retrograde amnesia.
Prevention
In order to prevent poisoning with Clonidine, you must adhere to the rules:
- do not use the drug without a doctor's prescription;
- when using the drug for therapeutic purposes, strictly adhere to the recommended dose and frequency of administration;
- Keep out of the reach of children;
- to prevent criminal poisoning, do not drink alcohol in the company of unfamiliar people.
Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
