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Alpha-2 Adrenergic and Imidazoline Receptor Agonists: Clonidine, Dexmedetomidine, and Related Antihypertensives, Decongestants, and Sedatives

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Abstract

Since the introduction of the imidazoline derivative clonidine, a topical nasal decongestant, in 1962, the number of agents in its class and the indications for their use have expanded greatly. Thousands of cases of clonidine exposure are reported to US poison centers annually (over 9700 exposures in 2014) with nearly 1 in 5 coded as resulting in moderate or major effect [1]. Exposures to guanfacine and other imidazolines increase the magnitude of the problem of alpha agonist exposures.

This is an update of a chapter written with Kevin L. Wallace in the first edition of this text.

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Authors and Affiliations

  1. Emergency Medicine, Yale School of Medicine, Yale New Haven Center for Emergency Preparedness and Disaster Response, New Haven, CT, USA

    Anthony J. Tomassoni

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  1. Anthony J. Tomassoni
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Correspondence to Anthony J. Tomassoni .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Clinical Pharmacology and Toxicology, University of Colorado, School of Medicine, Aurora, Colorado, USA

    Jeffrey Brent

  2. FDA, Office of New Drugs/Immediate Office, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas’ Hospital, Silver Spring, Maryland, USA

    Paul Dargan

  4. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Benjamin Hatten

  5. Medical Toxicological Intensive Care Unit, Lariboisiere Hospital, Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Robert Palmer

  7. Toxinology Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia

    Julian White

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Tomassoni, A.J. (2017). Alpha-2 Adrenergic and Imidazoline Receptor Agonists: Clonidine, Dexmedetomidine, and Related Antihypertensives, Decongestants, and Sedatives. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-17900-1_27

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