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Toxicity from a clonidine suspension.

Mariya Farooqi¹, Steven Seifert, Susan Kunkel

¹New Mexico Poison and Drug Information Center and University of New Mexico College of Pharmacy, Albuquerque, NM, USA.

Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology

|August 6, 2009

Summary

Clonidine overdose in children can cause severe effects. This case highlights potential dosing errors with compounded liquid medications, emphasizing the need for caution with such prescriptions.

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Area of Science:

Pediatric pharmacology
Medication safety
Clinical toxicology

Background:

Clonidine is commonly prescribed for children.
Clonidine overdose in pediatric patients can lead to severe clinical outcomes, including fatalities.
This case report addresses a potential clonidine overdose in a young child.

Observation:

A 3.5-year-old male with a history of seizures and night terrors presented with altered mental status, motor difficulties, and possible seizures.
The child was on chronic valproic acid (VPA) and clonidine therapy.
Clinical presentation included CNS depression, bradycardia, and miosis, consistent with clonidine toxicity, with a later serum clonidine level significantly above the reference range.

Findings:

A suspected accelerated dosing error of a pharmacy-compounded clonidine suspension was identified.
The child's symptoms resolved over 48 hours.
A significantly elevated serum clonidine level confirmed toxicity.

Implications:

Medication errors, particularly with extemporaneously compounded liquid formulations, pose a risk in pediatric care.
Careful attention is required for medications with narrow therapeutic indices, such as clonidine.
Enhanced vigilance in prescribing, compounding, and administration of liquid medications is crucial for preventing pediatric overdoses.