Review of clinical pharmacokinetics and pharmacodynamics of clonidine as an adjunct to opioids in palliative care.

Autor: Amna S; Department of Palliative Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark., Øhlenschlaeger T; Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark., Saedder EA; Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.; Department of Biomedicine, Aarhus University, Aarhus, Denmark., Sigaard JV; Department of Palliative Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark.; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark., Bergmann TK; Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark.; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.
Jazyk: angličtina
Zdroj: Basic & clinical pharmacology & toxicology [Basic Clin Pharmacol Toxicol] 2024 Apr; Vol. 134 (4), pp. 485-497. Date of Electronic Publication: 2024 Jan 26.
DOI: 10.1111/bcpt.13979
Abstrakt: Clonidine is an α-adrenoceptor agonist acting on receptors in the brain and peripheral tissues, leading to a reduction in sympathetic outflow and release of certain neurotransmitters. Clonidine has multiple uses across various medical conditions. One of its uses is as adjuvant to anaesthetic and analgesic agents specially opioids, mostly administered through intravenous and epidural routes. The opioids, effective in cancer pain management, are associated with various side effects such as sedation, pruritus, constipation, nausea, respiratory depression, tolerance and dependence. Combination of clonidine with opioids seems to help to achieve better pain management and less need of opioids. Use of clonidine in palliative care has been less common, but it is gradually gaining recognition for its potential benefits in managing symptoms like cancer pain and agitation. This combination approach has been explored in palliative care settings, including cancer pain and agitation, where patients experience complex and refractory symptoms. It seems to be well tolerated and gives better symptom relief. The available literature on clonidine's use in cancer pain and agitation management, especially in subcutaneous form, is limited and outdated. Therefore, the optimal dosing, safety profile and overall effectiveness of subcutaneous clonidine requires further exploration through prospective research studies.
(© 2024 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society). Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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