When do you hold clonidine?

[dbabz]

I work in a small psychiatric hospital serving children and adolescents. Recently, we've had a lot of kids prescribed clonidine (catapress) for ADHD and aggression. None of these prescriptions contain a hold order for low BP. At what level would you hold the meds and call the doc?

[VivaLasViejas, ASN, RN]

Call the doc and get parameters. They should be included whenever a patient is on clonidine. You may need to train your providers to write parameters in each case so you don't have to call them every time.

[dbabz]

Thanks!

[Meriwhen, ASN, BSN, MSN, RN]

I know the thread is a little old ?

Generally, clonidine is held if the SBP is under 90, DBP is under 60, or pulse is under 60. But I don't work with kids, so the "when to hold" guidelines may be different.

However, whatever parameters your prescriber gives trumps anything any of us can post here, so be sure to always those parameters whenever they give such an order.

[dbabz]

Thanks. We don't get parameters. Ever. I'm on my own in this regard.

[hppygr8ful, ASN, RN, EMT-I]

On 4/11/2019 at 2:29 PM, dbabz said:

Thanks. We don't get parameters. Ever. I'm on my own in this regard.

You can use a general rule of thumb and go with hold if S less than 90 D less than 60 and pulse less that 60. However when my medication nurse tells me they are holding due to low parameters we hydrate and run the patient around a bit. Then retake the vitals often times the vitals now indicate the meds can be given.

On the issue of including parameters talk to your pharmacy and administration parameters can be included in the order as a safety measure.

We are transitioning many of our adolescent patients to Tenex which can be given without regard to BP.

I once had adult patient on metoprolol and the order was to give without regard to BP because it was being given for arrhythmia.

Hppy

[dbabz]

Thanks hppygr8ful! We have many more patients on Tenex than clonidine, but seems like clonidine orders are on the rise.

[hppygr8ful, ASN, RN, EMT-I]

3 hours ago, dbabz said:

Thanks hppygr8ful! We have many more patients on Tenex than clonidine, but seems like clonidine orders are on the rise.

Probably an insurance thing - I think Clonidine is cheaper!

Hppy

[hppygr8ful, ASN, RN, EMT-I]

4 hours ago, hppygr8ful said:

You can use a general rule of thumb and go with hold if S less than 90 D less than 60 and pulse less that 60. However when my medication nurse tells me they are holding due to low parameters we hydrate and run the patient around a bit. Then retake the vitals often times the vitals now indicate the meds can be given.

On the issue of including parameters talk to your pharmacy and administration parameters can be included in the order as a safety measure.

We are transitioning many of our adolescent patients to Tenex which can be given without regard to BP.

I once had adult patient on metoprolol and the order was to give without regard to BP because it was being given for arrhythmia.

Hppy

Forgot to add that if you are holding based on your Nursing Judgement it goes without saying that you chart accurately and completely!

[dbabz]

"Probably an insurance thing - I think Clonidine is cheaper!"

Ha! Should have figured!