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Letter
Transdermal clonidine for agitation and pain
  1. Ashwin Ulagenthiran1,
  2. Paul Howard2,3 and
  3. John Curtin2,3
  1. 1General Medicine, Isle of Wight NHS Trust, Newport, Isle of Wight, UK
  2. 2Earl Mountbatten Hospice, Newport, Isle of Wight, UK
  3. 3Palliative Medicine, Isle of Wight NHS Trust, Newport, Isle of Wight, UK
  1. Correspondence to Paul Howard, Earl Mountbatten Hospice, Newport, Isle of Wight, UK; paul.howard1{at}nhs.net

https://doi.org/10.1136/spcare-2024-004872

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    Introduction

    Clonidine is an alpha-2 adrenergic agonist licensed in the UK for hypertension, menopausal hot flushes and migraine prophylaxis. Randomised controlled trials (RCTs) confirm clonidine’s analgesic benefit in cancer pain (spinal), postoperative pain (intravenous (IV) spinal) and neuropathic pain (spinal and oral).1 2 IV clonidine achieves comparable analgesia to epidural clonidine, although with more somnolence.3 Benefit is also reported for agitation, anxiety, diarrhoea, delirium, dystonia, hallucinations, nausea, opioid detoxification, Post-Traumatic Stress Disorder and respiratory panic.1 4 5

    The most common use in palliative medicine is subcutaneous (SC) administration for pain and terminal agitation.1 4 The parenteral and oral preparations can be given intranasally and sublingually, respectively.1 4

    However, we encountered a patient with cognitive impairment and unreliable oral route whose opioid poorly responsive pain and agitation responded well to clonidine, but who experienced significant distress with SC administration. We therefore imported a transdermal (TD) clonidine preparation from Italy. The patch comes in three sizes of 2.5, 5 and 7.5 mg (releasing 100, 200 and 300 µg/day, respectively) and is changed once weekly. In addition to the medicated plaster, the box contains a second adhesive overlay to improve patch adherence (see online supplemental appendix). Because the TD route was acceptable and the patient’s symptoms remained controlled, we subsequently used it in similar situations. Since it appeared to be a valuable new option for selected patients, we undertook a retrospective chart review of TD clonidine use.

    Supplemental material

    [spcare-2024-004872supp001.pdf]

    Methods

    Patients receiving TD clonidine in a single palliative care centre were identified via our local …

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    Footnotes

    • Twitter @Paul_Howard_IoW

    • Contributors AU and JC jointly conceived and conducted the audit; AU and JC coanalysed the data; AU, 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; internally peer reviewed.

    • 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.