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Efficacy and safety of subcutaneous clonidine for refractory symptoms in palliative medicine: a retrospective study
  1. Paul Howard1,2 and
  2. John Curtin1,2
  1. 1Mountbatten Hospice, Newport, Isle of Wight, UK
  2. 2Palliative Care Team, Isle of Wight NHS Trust, Newport, Isle of Wight, UK
  1. Correspondence to Dr Paul Howard, Mountbatten Hospice, Newport, Isle of Wight, UK; paul.howard1{at}


Objectives To investigate the efficacy and safety of subcutaneous clonidine for refractory symptoms in the palliative setting.

Methods A retrospective chart review of the use of subcutaneous clonidine in a single palliative care centre. We reviewed the use of clonidine since it was introduced in our locality 2½ years ago. All clinical notes, medication administration records and infusion monitoring documentation were examined to ascertain therapeutic aim, efficacy and tolerability.

Results Subcutaneous clonidine was administered to 113 patients. Recipients were generally frail (median Karnofsky Score 20%) and in the last weeks of life (median survival 6 days). The the most common indications were opioid poorly responsive pain (59), agitation refractory to antipsychotics and/or benzodiazepines (18) or both (35). Symptoms appeared to improve in the majority (85/113, 75%). Some (36, 32%) required no further medication changes once clonidine was commenced. Clonidine appeared well tolerated although blood pressure was not monitored in the majority, in line with our practice to discontinue such observations in those who are nursed in bed and receiving symptom-focused care.

Conclusions Subcutaneous administration of clonidine appears to be a promising alternative option for refractory symptoms in the last weeks of life. We suggest some possible next steps for further research.

  • Pain
  • Terminal care

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  • Contributors PH and JC jointly conceived and conducted the audit; PH analysed the data; PH and JC jointly wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PH is an editor for the neuropharmacology sections of the Palliative Care Formulary, and has contributed to updating the clonidine monograph.

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

  • Twitter Paul Howard @Paul_Howard_IoW

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.