Evaluation of Institution-Specific Strategy for Converting Dexmedetomidine to Clonidine in a Pediatric Cardiac Intensive Care Unit.

This study aimed to evaluate the success and safety of an institution-specific strategy for converting dexmedetomidine to clonidine in the cardiac intensive care unit at a tertiary care pediatric hospital. This retrospective descriptive study included pediatric patients under 18 years of age receiving at least 7 days of dexmedetomidine infusion before conversion to clonidine between January 1, 2018, and October 1, 2023. A successful conversion was defined as dexmedetomidine infusion discontinuation in the absence of therapy reinitiation within 36 hours after the initial enteral clonidine dose; no dose increases greater than 15% within 36 hours of initial clonidine dose, and no requirement for supplemental doses. Patients with dexmedetomidine discontinuation before completing stepwise conversion were evaluated for adverse drug events (ADEs). Descriptive statistics were used to analyze the data. A total of 148 episodes of conversion from dexmedetomidine to clonidine were evaluated for 134 patients. Patient demographics and treatment characteristics included a median age at conversion of 4.6 months (IQR, 1.5-7.1), a median duration of dexmedetomidine exposure of 19 days (IQR, 12-34), a median initial clonidine dose of 9.3 mcg/kg/day (IQR, 7.2-10), and a median time to discontinuation of 19 hours (IQR, 17-36) after the first dose of clonidine. Successful conversion occurred in 99 (67%) of episodes evaluated, and no ADEs were identified. The conversion allowed for most patients to tolerate the conversion to clonidine, and no ADEs were identified.