Building on a case report¹ published earlier this year, we wish to present another two interesting cases where the novel use of clonidine has effectively resolved chronic treatment-refractory diarrhoea. There is currently minimal literature on how to manage chronic diarrhoea in a palliative setting, and in this presentation, we will summarise and outline a treatment algorithm. We will also discuss the beginnings of our prospective case series audit, looking into patient-reported outcome measures post clonidine for opioid-refractory chronic diarrhoea, presently taking place at the Wesley Hospital, Brisbane. Diarrhoea can be a distressing symptom and occurs in about 6% of advanced cancer and 7–10% of hospice patients.¹ Currently, there is a spotlight on clonidine and its use in palliative care for pain and terminal agitation management. Its use, however, for palliative diarrhoea management has only briefly been discussed, more than 30 years ago, and is not part of standard practice. We wish to challenge the current treatment patterns and transform the recommendations for chronic diarrhoea in palliative care. Clonidine has been found to be beneficial in multiple aetiologies of diarrhoea but especially in autonomic enteropathy. We will present cases where clonidine has successfully treated chronic diarrhoea secondary to recurrent coeliac plexus blocks, short gut syndrome and chemotherapy/infection. These cases, also demonstrate clonidine’s effectiveness, where octreotide, the current last-line of treatment, has failed. Within one week of commencing clonidine, we saw an improvement in the frequency and consistency of diarrhoea for our patients, ultimately leading to the resolution of the symptom, without significant adverse events.

Reference

1. Kahawita T, Leong LJP, McConaghy JR. The use of clonidine to manage chronic refractory diarrhoea in a palliative patient: a case report. Progress in Palliative Care. Published online: 07 Feb 2024.