Clonidine Hold Parameters for an 11-Year-Old Female
For an 11-year-old female on clonidine, instruct nursing to hold the dose and notify the provider if systolic blood pressure falls below 90 mmHg or heart rate drops below 60 beats per minute.
Blood Pressure Hold Parameters
- Hold clonidine if systolic BP <90 mmHg or diastolic BP <50 mmHg 1, 2
- Clonidine causes dose-dependent hypotension with maximum blood pressure decrease occurring 2-4 hours after oral administration 2
- In pediatric studies, even low doses (0.625-1.25 mcg/kg) caused significant blood pressure reductions compared to control 3
- The FDA label documents that hypotension is a major adverse effect requiring monitoring, particularly during therapy initiation 2
Heart Rate Hold Parameters
- Hold clonidine if heart rate <60 beats per minute 1, 4
- Bradycardia is a consistent finding in clonidine overdose and therapeutic use, with median minimum heart rates of 48 bpm documented in adult overdose cases 4
- In a pediatric compounding error case, a 12-year-old developed severe bradycardia (30-40 beats/min) requiring multiple doses of atropine 5
- Pulse monitoring is specifically mandated in ADHD treatment guidelines for children receiving clonidine 1
Critical Monitoring Considerations
- Check blood pressure and heart rate before each dose administration 1, 6
- Monitor particularly closely during the first 2-4 hours post-dose when peak effects occur 2
- Standing/orthostatic blood pressure should be assessed, as clonidine impairs blood pressure recovery after position changes and can cause significant orthostatic hypotension 1, 7
- Document baseline supine and standing vital signs before initiating therapy 8
Additional Safety Parameters
- Hold for excessive sedation or altered mental status (GCS <13) 2, 5, 4
- Central nervous system depression occurs in 68% of clonidine overdoses and may be more frequent in children than adults 2, 4
- Miosis (pinpoint pupils) may accompany toxicity but occurs in only 29% of cases 4
- As little as 0.1 mg has produced signs of toxicity in children 2
Common Pitfall to Avoid
- Never abruptly discontinue clonidine once established on therapy - this can cause severe rebound hypertension and tachycardia requiring gradual tapering over 2-4 days 9, 8
- If doses are being held for hypotension/bradycardia, notify the prescriber immediately rather than simply continuing to hold doses, as withdrawal syndrome can develop 1, 6