Failure of naloxone to reverse clonidine toxic effect

Acute ingestions of imidazoline compounds, including clonidine hydrochloride, are a recognized clinical entity. The signs and symptoms of this overdose superficially resemble those of opiate intoxication, leading to attempts to reverse this poisoning with naloxone hydrochloride. Despite previous descriptions of success using naloxone in acute clonidine poisoning, five cases of acute pediatric ingestions of clonidine ranging from mild to severe occurred in which naloxone hydrochloride in doses up to 0.1 mg/kg was unsuccessful in reversing the signs and symptoms of this intoxicant. Although naloxone can be safely administered to children who ingest clonidine to distinguish them from those who are intoxicated by opiates, it is not therapeutically useful to use naloxone to reverse poisoning with this class of agents.