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Tang F, Bada H, Ng CM, Leggas M. Validation of a HPLC/MS method for simultaneous quantification of clonidine, morphine and its metabolites in human plasma. Biomed Chromatogr 2019; 33:e4527. [PMID: 30830964 DOI: 10.1002/bmc.4527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/20/2019] [Accepted: 02/26/2019] [Indexed: 11/08/2022]
Abstract
A high-performance liquid chromatography-tandem mass spectrometry method was developed and validated for the simultaneous quantification of morphine, morphine's major metabolites morphine-3-glucuronide and morphine-6-glucuronide, and clonidine, to support the pharmacokinetic analysis of an ongoing double-blinded randomized clinical trial that compares the use of morphine and clonidine in infants diagnosed with neonatal abstinence syndrome. Plasma samples were processed by solid-phase extraction and separated on an Inertsil ODS-3 (4 μm) column using an 0.1% formic acid in water-0.1% formic acid in methanol gradient. Detection of the analytes was conducted in the positive multiple reaction monitoring mode. The range of quantitation was 1-1000 ng/mL for morphine, morphine-3-glucuronide and morphine-6-glucuronide, and 0.25-100 ng/mL for clonidine. Intra-day and inter-day accuracy and precision were ≤15% for all analytes across the quantitation range. Extraction recovery rates were ≥94% for morphine, ≥90% for M3G, ≥87% for M6G and ≥ 79% for clonidine. Matrix effect ranged from 85-94% for clonidine to 101-106% for M3G. The method fulfilled all predetermined acceptance criteria and required only 100 μL of starting plasma volume. Furthermore, it was successfully applied to 30 clinical trial plasma samples.
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Affiliation(s)
- Fei Tang
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY, USA.,Center for Pharmaceutical Research and Innovation, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Henrietta Bada
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Chee M Ng
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY, USA
| | - Markos Leggas
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY, USA.,Center for Pharmaceutical Research and Innovation, College of Pharmacy, University of Kentucky, Lexington, KY, USA
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2
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Hov KR, Neerland BE, Andersen AM, Undseth Ø, Wyller VB, MacLullich AMJ, Skovlund E, Qvigstad E, Wyller TB. The use of clonidine in elderly patients with delirium; pharmacokinetics and hemodynamic responses. BMC Pharmacol Toxicol 2018; 19:29. [PMID: 29884231 PMCID: PMC5994030 DOI: 10.1186/s40360-018-0218-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 05/22/2018] [Indexed: 01/29/2023] Open
Abstract
Background The Oslo Study of Clonidine in Elderly Patients with Delirium (LUCID) is an RCT investigating the effect of clonidine in medical patients > 65 years with delirium. To assess the dosage regimen and safety measures of this study protocol, we measured the plasma concentrations and hemodynamic effects of clonidine in the first 20 patients. Methods Patients were randomised to clonidine (n = 10) or placebo (n = 10). The treatment group was given a loading dose (75μg every 3rd hour up to a maximum of 4 doses) to reach steady state, and further 75μg twice daily until delirium free for 2 days, discharge or a maximum of 7 days. Blood pressure (BP) and heart rate (HR) were measured just before every dose. If the systolic BP was < 100 mmHg or HR < 50 beats per minute the next dose was omitted. Plasma concentrations of clonidine were measured 3 h after each drug intake on day 1, just before intake (day 2 and at steady state day 4–6) and 3 h after intake at steady state (Cmax). Our estimated pre-specified plasma concentration target range was 0.3–0.7μg/L. Results 3 h after the first dose of 75μg clonidine, plasma concentration levels rose to median 0.35 (range 0.24–0.40)μg/L. Median trough concentration (C0) at day 2 was 0.70 (0.47–0.96)μg/L. At steady state, median C0 was 0.47 (0.36–0.76)μg/L, rising to Cmax 0.74 (0.56–0.95)μg/L 3 h post dose. A significant haemodynamic change from baseline was only found at a few time-points during the loading doses within the clonidine group. There was however extensive individual BP and HR variation in both the clonidine and placebo groups, and when comparing the change scores (delta values) between the clonidine and the placebo groups, there were no significant differences. Conclusions The plasma concentration of clonidine was at the higher end of the estimated therapeutic range. Hemodynamic changes during clonidine treatment were as expected, with trends towards lower blood pressure and heart rate in patients treated with clonidine, but with dose adjustments based on SBP this protocol appears safe. Trial registration ClinicalTrials.gov NCT01956604, 09.25.2013. EudraCT Number: 2013–000815-26, 03.18.2013. Enrolment of first participant: 04.24.2014.
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Affiliation(s)
- Karen Roksund Hov
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjørn Erik Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Øystein Undseth
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Vegard Bruun Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Paediatrics, Akershus University Hospital, Lørenskog, Norway
| | - Alasdair M J MacLullich
- Edinburgh Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, UK
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eirik Qvigstad
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Torgeir Bruun Wyller
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Feng M, Suryoprabowo S, Tao H, Liu L, Zheng Q, Kuang H. Rapid detection of clonidine and its cross-reactivity with apraclonidine in pig urine using an immunochromatographic test strip. FOOD AGR IMMUNOL 2018. [DOI: 10.1080/09540105.2018.1460325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Min Feng
- Huaian Entry-Exit Inspection and Quarantine Bureau, Huaian, People’s Republic of China
| | - Steven Suryoprabowo
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People’s Republic of China
- International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People’s Republic of China
- Collaborative Innovationcenter of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi, People’s Republic of China
| | - Hong Tao
- National Institute of Metrology, Beijing, People’s Republic of China
| | - Liqiang Liu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People’s Republic of China
- International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People’s Republic of China
- Collaborative Innovationcenter of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi, People’s Republic of China
| | | | - Hua Kuang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People’s Republic of China
- International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People’s Republic of China
- Collaborative Innovationcenter of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, Wuxi, People’s Republic of China
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Veigure R, Aro R, Metsvaht T, Standing JF, Lutsar I, Herodes K, Kipper K. A highly sensitive method for the simultaneous UHPLC-MS/MS analysis of clonidine, morphine, midazolam and their metabolites in blood plasma using HFIP as the eluent additive. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1052:150-157. [PMID: 28388512 DOI: 10.1016/j.jchromb.2017.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/01/2017] [Accepted: 03/09/2017] [Indexed: 10/20/2022]
Abstract
In intensive care units, the precise administration of sedatives and analgesics is crucial in order to avoid under- or over sedation and for appropriate pain control. Both can be harmful to the patient, causing side effects or pain and suffering. This is especially important in the case of pediatric patients, and dose-response relationships require studies using pharmacokinetic-pharmacodynamic modeling. The aim of this work was to develop and validate a rapid ultra-high performance liquid chromatographic-tandem mass spectrometric method for the analysis of three common sedative and analgesic agents: morphine, clonidine and midazolam, and their metabolites (morphine-3-glucuronide, morphine-6-glucuronide and 1'-hydroxymidazolam) in blood plasma at trace level concentrations. Low concentrations and low sampling volumes may be expected in pediatric patients; we report the lowest limit of quantification for all analytes as 0.05ng/mL using only 100μL of blood plasma. The analytes were separated chromatographically using the C18 column with the weak ion-pairing additive 1,1,1,3,3,3-hexafluoro-2-propanol and methanol. The method was fully validated and a matrix matched calibration range of 0.05-250ng/mL was attained for all analytes In addition, between-day accuracy for all analytes remained within 93-108%, and precision remained within 1.5-9.6% for all analytes at all concentration levels over the calibration range.
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Affiliation(s)
- Rūta Veigure
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
| | - Rudolf Aro
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
| | - Tuuli Metsvaht
- Tartu University Hospital, Lunini 6, 51014 Tartu Estonia
| | - Joseph F Standing
- Inflammation, Infection and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom
| | - Irja Lutsar
- University of Tartu, Institute of Microbiology, 19 Ravila Street, 50411 Tartu, Estonia
| | - Koit Herodes
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
| | - Karin Kipper
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.
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Fagermoen E, Sulheim D, Winger A, Andersen AM, Gjerstad J, Godang K, Rowe PC, Saul JP, Skovlund E, Wyller VB. Effects of low-dose clonidine on cardiovascular and autonomic variables in adolescents with chronic fatigue: a randomized controlled trial. BMC Pediatr 2015; 15:117. [PMID: 26357864 PMCID: PMC4566847 DOI: 10.1186/s12887-015-0428-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background Chronic Fatigue Syndrome (CFS) is a common and disabling condition in adolescence with few treatment options. A central feature of CFS is orthostatic intolerance and abnormal autonomic cardiovascular control characterized by sympathetic predominance. We hypothesized that symptoms as well as the underlying pathophysiology might improve by treatment with the alpha2A–adrenoceptor agonist clonidine. Methods A total of 176 adolescent CFS patients (12–18 years) were assessed for eligibility at a single referral center recruiting nation-wide. Patients were randomized 1:1 by a computer system and started treatment with clonidine capsules (25 μg or 50 μg twice daily, respectively, for body weight below/above 35 kg) or placebo capsules for 9 weeks. Double-blinding was provided. Data were collected from March 2010 until October 2012 as part of The Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL). Effect of clonidine intervention was assessed by general linear models in intention-to-treat analyses, including baseline values as covariates in the model. Results A total of 120 patients (clonidine group n = 60, placebo group n = 60) were enrolled and started treatment. There were 14 drop-outs (5 in the clonidine group, 9 in the placebo group) during the intervention period. At 8 weeks, the clonidine group had lower plasma norepinephrine (difference = 205 pmol/L, p = 0.05) and urine norepinephrine/creatinine ratio (difference = 3.9 nmol/mmol, p = 0.002). During supine rest, the clonidine group had higher heart rate variability in the low-frequency range (LF-HRV, absolute units) (ratio = 1.4, p = 0.007) as well as higher standard deviation of all RR-intervals (SDNN) (difference = 12.0 ms, p = 0.05); during 20° head-up tilt there were no statistical differences in any cardiovascular variable. Symptoms of orthostatic intolerance did not change during the intervention period. Conclusions Low-dose clonidine reduces catecholamine levels in adolescent CFS, but the effects on autonomic cardiovascular control are sparse. Clonidine does not improve symptoms of orthostatic intolerance. Trial registration Clinical Trials ID: NCT01040429, date of registration 12/28/2009.
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Affiliation(s)
- Even Fagermoen
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, P.O.Box 1171, Blindern, 0318, Oslo, Norway. .,Department of Anaesthesiology and Critical Care, Oslo University Hospital, P.O.Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Dag Sulheim
- Department of Paediatrics, Oslo University Hospital, P.O.Box 4950, Nydalen, 0424, Oslo, Norway. .,Department of Paediatrics, Lillehammer County Hospital, P.O.Box 104, 2381, Brumunddal, Norway.
| | - Anette Winger
- Institute of Nursing Sciences, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St., Olavs plass, 0130, Oslo, Norway.
| | - Anders M Andersen
- Department of Pharmacology, Oslo University Hospital, P.O.Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Johannes Gjerstad
- National Institute of Occupational Health, P.O Box 8149, Dep, 0033, Oslo, Norway. .,Department of Biosciences, University of Oslo, P.O.Box 1066, Blindern, 0316, Oslo, Norway.
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, P.O.Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Peter C Rowe
- Department of Paediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - J Philip Saul
- Department of Paediatrics, Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC, 29425, USA.
| | - Eva Skovlund
- Department of Pharmaceutical Science, University of Oslo, P.O.Box 1068, Blindern, 0316, Oslo, Norway. .,Norwegian Institute of Public Health, P.O.Box 4404, Nydalen, 0403, Oslo, Norway.
| | - Vegard Bruun Wyller
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, P.O.Box 1171, Blindern, 0318, Oslo, Norway. .,Department of Paediatrics, Akershus University Hospital, P.O.Box 1000, 1478, Lørenskog, Norway.
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Zhuang J, Chen J, Wang X, Pang Y, Bi H, Huang L, Zeng G, Liao X, Ma Z, Chen X, Zhong G, Huang M, Zhao X. Validation of a HPLC-ESI MS/MS method for the determination of clonidine in human plasma and its application in a bioequivalence study in Chinese healthy volunteers. Biomed Chromatogr 2015; 29:1506-13. [DOI: 10.1002/bmc.3450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/22/2014] [Accepted: 01/19/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Jialang Zhuang
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences; Sun Yat-Sen University; Guang Zhou 510006 China
| | - Jiangying Chen
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences; Sun Yat-Sen University; Guang Zhou 510006 China
| | - Xueding Wang
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences; Sun Yat-Sen University; Guang Zhou 510006 China
| | - Yin Pang
- Sun Yat-sen University Cancer Center; Guang Zhou 510060 China
| | - Huichang Bi
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences; Sun Yat-Sen University; Guang Zhou 510006 China
| | - Lihui Huang
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences; Sun Yat-Sen University; Guang Zhou 510006 China
| | - Guixiong Zeng
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences; Sun Yat-Sen University; Guang Zhou 510006 China
| | - Xiaoxing Liao
- The First Affiliated Hospital; Sun Yat-Sen University; Guang Zhou 510080 China
| | - Zhongfu Ma
- The First Affiliated Hospital; Sun Yat-Sen University; Guang Zhou 510080 China
| | - Xiao Chen
- The First Affiliated Hospital; Sun Yat-Sen University; Guang Zhou 510080 China
| | - Guoping Zhong
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences; Sun Yat-Sen University; Guang Zhou 510006 China
| | - Min Huang
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences; Sun Yat-Sen University; Guang Zhou 510006 China
| | - Xianglan Zhao
- Laboratory of Drug Metabolism and Pharmacokinetics, School of Pharmaceutical Sciences; Sun Yat-Sen University; Guang Zhou 510006 China
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Qin J, Wang L, Wu L, Chen J, Shen T, Li Y, Han L, Wang J. Development of an LC-MS/MS method for determining the pharmacokinetics of clonidine following oral administration of Zhenju antihypertensive compound. Biomed Chromatogr 2014; 29:1068-75. [PMID: 25516086 DOI: 10.1002/bmc.3393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 10/13/2014] [Accepted: 10/23/2014] [Indexed: 11/05/2022]
Abstract
Zhenju antihypertensive compound (ZJAHC) is a combined Chinese-Western medicine formula including clonidine (CLO), hydrochlorothiazide (HCT), rutin, Chrysanthemum indicum extract and pearl powder. Compared with CLO preparations, ZJAHC shows improved activities and decreased adverse effects. It is believed that the side effects of CLO are caused by its high peak plasma concentration. Hence, study of the influence of ZJAHC on the pharmacokinetic behaviors of clonidine seems essential. In present study, the plasma concentrations of CLO were determined with a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. The MS/MS transitions monitored for clonidine and internal standard were 230.2 → 213.1 and 152.2 → 110.2, respectively. The analyte was quantified in a single run within 3 min. The pharmacokinetic study showed that the area under the plasma concentration-time curve of CLO in ZJAHC (60 µg/kg CLO) was similar to that of CLO-HCT-high (120 µg/kg CLO) but the peak concentration was much lower than that in CLO-HCT-high. ZJAHC could enhance the bioavailability without greatly increasing peak concentration of clonidine. This comprehensive effect of enhancing the bioavailability and avoiding the high peak plasma concentration for CLO might mainly result from the co-contribution of Western medicine and traditional Chinese medicine (TCM), while the effect of TCM was stronger than that of Western medicine.
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Affiliation(s)
- Jing Qin
- Department of Pharmaceutics, School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, Fudan University, Shanghai, 201203, China
| | - Limin Wang
- Department of Pharmaceutics, School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, Fudan University, Shanghai, 201203, China
| | - Lihong Wu
- Department of Pharmaceutics, School of Pharmacy, Heilongjiang University of Chinese Medicine, Haerbin, Heilongjiang Province, 150040, China
| | - Jun Chen
- Department of Pharmaceutics, School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, Fudan University, Shanghai, 201203, China
| | - Teng Shen
- Department of Pharmaceutics, School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, Fudan University, Shanghai, 201203, China
| | - Yongji Li
- Department of Pharmaceutics, School of Pharmacy, Heilongjiang University of Chinese Medicine, Haerbin, Heilongjiang Province, 150040, China
| | - Limei Han
- Department of Pharmaceutics, School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, Fudan University, Shanghai, 201203, China
| | - Jianxin Wang
- Department of Pharmaceutics, School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, Fudan University, Shanghai, 201203, China
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Continuous infusion of clonidine in ventilated newborns and infants: a randomized controlled trial. Pediatr Crit Care Med 2014; 15:511-22. [PMID: 24751788 DOI: 10.1097/pcc.0000000000000151] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the influence of an infusion of clonidine 1 μg/kg/hr on fentanyl and midazolam requirement in ventilated newborns and infants. DESIGN Prospective, double-blind, randomized controlled multicenter trial. Controlled trials.com/ISRCTN77772144. SETTING Twenty-eight level 3 German PICUs/neonatal ICUs. PATIENTS Ventilated newborns and infants: stratum I (1-28 d), stratum II, (29-120 d), and stratum III (121 d to 2 yr). INTERVENTIONS Patients received clonidine 1 μg/kg/hr or placebo on day 4 after intubation. Fentanyl and midazolam were adjusted to achieve a defined level of analgesia and sedation according to Hartwig score. MEASUREMENTS AND MAIN RESULTS Two hundred nineteen infants were randomized; 212 received study medication, 69.7% were ventilated in the postoperative care and 30.3% for other reasons. Primary endpoint: consumption of fentanyl and midazolam in the 72 hours following the onset of study medication (main observation period) in the overall study population. The confirmatory analysis of the overall population showed no difference in the consumption of fentanyl and midazolam. Explorative age-stratified analysis demonstrated that in stratum I (n = 112) the clonidine group had a significantly lower consumption of fentanyl (clonidine: 2.1 ± 1.8 μg/kg/hr, placebo: 3.2 ± 3.1 μg/kg/hr; p = 0.032) and midazolam (clonidine: 113.0 ± 100.1 μg/kg/hr, placebo: 180.2 ± 204.0 μg/kg/hr; p = 0.030). Strata II (n = 43) and III (n = 46) showed no statistical difference. Sedation and withdrawal-scores were significantly lower in the clonidine group of stratum I (p < 0.001). Frequency of severe adverse events did not differ between groups. CONCLUSIONS Clonidine 1 μg/kg/hr in ventilated newborns reduced fentanyl and midazolam demand with deeper levels of analgesia and sedation without substantial side effects. This was not demonstrated in older infants, possibly due to lower clonidine serum levels.
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Bai Y, Liu Z, Wang H, Bi Y, Huang Y, Sun L, Su F, Jin Y, Zhang C, Xu S. Development of a rapid and sensitive enzyme-linked immunosorbent assay to detect clonidine residues in swine urine samples. FOOD AGR IMMUNOL 2013. [DOI: 10.1080/09540105.2013.858663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Fagermoen E, Sulheim D, Winger A, Andersen AM, Vethe NT, Saul JP, Thaulow E, Wyller VB. Clonidine in the treatment of adolescent chronic fatigue syndrome: a pilot study for the NorCAPITAL trial. BMC Res Notes 2012; 5:418. [PMID: 22871021 PMCID: PMC3461473 DOI: 10.1186/1756-0500-5-418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 07/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This pilot study (ClinicalTrials.gov ID: NCT01507701) assessed the feasibility and safety of clonidine in adolescent chronic fatigue syndrome (CFS). Specifically, we assessed clonidine dosage in relation to a) plasma concentration levels, b) orthostatic cardiovascular responses, and c) possible adverse effects. FINDINGS Five adolescent CFS patients (14-19 years old) received 50 μg clonidine twice per day during 14 days in an open, uncontrolled design. Plasma concentration of clonidine was assayed by standard laboratory methods. Changes in orthostatic cardiovascular responses were assessed by a 20o head-up tilt-test (HUT). Adverse effects were mapped by a questionnaire.After 14 days, C0 median (range) of clonidine was 0.21 (0.18-0.36) μg/L, and Cmax median (range) of clonidine was 0.41 (0.38-0.56) μg/L. Also, supine blood pressures and heart rate were lower during clonidine treatment, and the HUT response was closer to the normal response. No serious adverse effects were registered. CONCLUSION Clonidine 50 μg BID seems to be safe enough to proceed from a pilot study to a controlled trial in a select group of adolescents with CFS (ClinicalTrials.gov ID: NCT01040429).
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Affiliation(s)
- Even Fagermoen
- Department of Pediatrics, Oslo University Hospital and University of Oslo, Oslo, Norway
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Gonzalez SI, La Belle JT. The Development of an At-Risk Biosensor for Cardiovascular Disease. ACTA ACUST UNITED AC 2012. [DOI: 10.4303/bj/235493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ghosh C, Singh RP, Inamdar S, Mote M, Chakraborty BS. Sensitive, Selective, Precise and Accurate LC–MS Method for Determination of Clonidine in Human Plasma. Chromatographia 2009. [DOI: 10.1365/s10337-009-1102-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nirogi R, Kandikere V, Mudigonda K, Komarneni P. Liquid chromatography tandem mass spectrometry method for the quantification of clonidine with LLOQ of 10 pg/mL in human plasma. Biomed Chromatogr 2008; 22:992-1000. [DOI: 10.1002/bmc.1018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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Parekh SA, Pudage A, Joshi SS, Vaidya VV, Gomes NA. Rapid and sensitive liquid chromatography–tandem mass spectrometry (LC–MS/MS) method for the determination of clonidine in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2008; 867:172-8. [DOI: 10.1016/j.jchromb.2008.03.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 03/15/2008] [Accepted: 03/26/2008] [Indexed: 11/27/2022]
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