Clonidine use during dexmedetomidine weaning: A systematic review

Table 2 Dosing schemes reported in study methods

Ref.	Formal protocol	Dexmedetomidine indication	Threshold for clonidine use	Initial clonidine dose	Dexmedetomidine wean	Clonidine taper
Terry et al[24], 2015	No	Primarily for sedation after cardiac surgery	No standard	No standard. 0.1 mg three times daily commonly used	No standard	No standard
Gagnon et al[23], 2015	Yes	Agitation: 12 (60%); Alcohol withdrawal: 3 (15%); Delirium: 2 (10%); Intolerance to other sedatives: 3 (15%)	Hemodynamically stable patients; Favorable response to DEX for 12-24 h	0.2-0.5 mg every 6 h; Start at 0.2 mg with DEX doses of < 0.7 µg/kg/h, weight < 100 kg or age > 65 yr; Start with 0.5 mg every 6 h for all other patients	Decrease DEX dose by 25% of baseline within 6 h of clonidine administration (as long as no rescue meds were needed for agitation)	Extend the dosing interval to every 8, 12 and 24 h every 1-2 d as tolerated until discontinuation
Bhatt et al[22], 2020	Yes	No clear selection criteria; patients with substance withdrawal were excluded	Variable; Clonidine taper and DEX wean started together	0.3 or 0.2 mg every 6 h; Start at 0.2 mg with DEX < 0.7 µg/kg/h, weight < 100 kg, age > 65 yr old; Start with 0.3 mg every 6 h for all other patients	Decrease DEX dose by 25% of baseline from 0 h to 6 h, and continue dose reduction by 25% every 6 h while on clonidine	Extend the dosing interval to every 8, 12 and 24 h every 1-2 d as tolerated until discontinuation

DEX: Dexmedetomidine.