Clonidine to Treat Iatrogenic-induced Opioid Dependence in Infants
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| ClinicalTrials.gov Identifier: NCT01360450 |
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Recruitment Status :
Terminated
(The study was treminated because of low accural)
First Posted : May 25, 2011
Results First Posted : September 13, 2017
Last Update Posted : September 13, 2017
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Sponsor:
Johns Hopkins University
Collaborator:
National Institute on Drug Abuse (NIDA)
Information provided by (Responsible Party):
Johns Hopkins University
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Brief Summary:
Thousands of critically ill infants (and children) are exposed to opioids and benzodiazepines to achieve sedation and analgesia as part of routine care in neonatal and pediatric intensive care units. While the use of these agents are undisputedly beneficial in reducing pain and anxiety, improving ventilation, reducing pulmonary vascular resistance and improving outcomes; the consequence is often the development of tolerance and physiologic dependence - similar to prenatal exposure from these same classes of drugs. The investigators have recently reported the results of randomized placebo control trial showing that the addition of clonidine (central alpha 2 agonist) to tapering doses of opioids was efficacious and safe in treating opioid dependence in infants who had moderate to severe neonatal abstinence syndrome from prenatal drug exposure to opioids. Currently, the investigators propose to perform a double-blind, randomized placebo control trial in a cohort of critically ill infants without prenatal drug exposure at Johns Hopkins Hospital to test the overall hypothesis that early addition of clonidine to a cohort of critically ill neonates on mechanical ventilation who are receiving opioids and benzodiazepines for analgesia and sedation will be efficacious and safe in reducing both the incidence and severity of withdrawal symptoms (NICU-NAS); as well as, reducing the time to complete sedative and analgesic drug detoxification. The hypothesis will be tested by addressing 2 specific aims that will determine: 1) the efficacy and safety of clonidine in critically ill infants, and 2) pharmacokinetics and pharmacodynamics using population-based pharmacokinetics in this vulnerable infant population who have only been exposed to these drugs as part of their routine care. Many "standard of care practices" are incorporated in neonatal and pediatric care prior to evidence based studies. This proposal will fill a much needed gap in translating what the investigators have learned about basic mechanisms mediating dependence and withdrawal to proven therapies for vulnerable pediatric populations.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Neonatal Abstinence Syndrome | Drug: Clonidine HCL Drug: saline | Phase 2 Phase 3 |
The study will test the following 2 specific aims:
Specific Aim 1
To determine the efficacy and short-term safety of clonidine in reducing the severity of iatrogenic neonatal abstinence syndrome (NAS) by decreasing the time required for complete sedative and analgesic drug detoxification. The investigators will enroll 88 neonates at risk for having moderate to severe NAS in a randomized, double-blinded placebo controlled trial comparing opioid/benzodiazepine administration combined with a placebo (control) vs. opioid/benzodiazepine combined with clonidine. Principal outcome measure will be the difference in length of treatment for complete detoxification. Early safety of clonidine will be determined by monitoring for cardiorespiratory side effects that might be associated with clonidine use in this high risk population.
Specific Aim 2
To determine the pharmacokinetics and pharmacodynamics of clonidine in this critically ill infant population. The investigators will estimate the dose-exposure-response relationship of clonidine in neonates at risk for developing iatrogenic by using nonlinear mixed-effects population pharmacokinetic (PK)-pharmacodynamic (PD) analysis.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 12 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
| Primary Purpose: | Treatment |
| Official Title: | Efficacy of Clonidine in Reducing Iatrogenic-induced Opioid Dependence in Infants: |
| Study Start Date : | July 2011 |
| Actual Primary Completion Date : | July 2011 |
| Actual Study Completion Date : | December 2014 |
Resource links provided by the National Library of Medicine
Genetics Home Reference related topics:
Opioid addiction
| Arm | Intervention/treatment |
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Experimental: Treatment
Interventions: Infants will receive intravenous or oral clonidine(Duraclon) for the treatment of pain and sedation: Duration: (Clonidine HCL) 1 mcg/kg/dose q4 either iv or po.
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Drug: Clonidine HCL
At day 5 on opioid and/or benzodiazepine (BZD), the infant will be randomized to receive either placebo (normal saline) or clonidine 1μg/kg/q 4 hrs to a maximum dose of 2μg/kg/q 4. Weaning from the study drug: When the opioid is no longer required, 24 hrs later the study drug (placebo or study drug) will be reduced by 50% and then discontinued 24 hours later provided that the Modified Finnegan scores remain between < 9.
Other Name: Duraclon |
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Placebo Comparator: Control
Intervention: Infants will receive place (saline) (if receiving it IV) or orally (sterile water) if receiving it orally
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Drug: saline
Infants randomized to placebo will be administered IV saline or oral sterile water in the same volume as study drug. The placebo will be give every 4 hrs as outlined in the algorithm for the study.
Other Name: placebo, sterile water, saline |
Primary Outcome Measures :
- Time to Complete Detoxification [ Time Frame: up to 4 weeks ]Time to complete detoxification is defined as 48 hrs off all opioids/benzodiazepines and study drug with acceptable withdrawal scores of <9 (on average we expect the infant to be enrolled in the study for 2-4 weeks). The scale used to assess withdrawal was the Modified Finnegan Neonatal Withdrawal Scale, which ranges from 0-41, 0 represents no withdrawal and 41 represent maximum withdrawal.
Secondary Outcome Measures :
- Cardiovascular Side-effects Changes HR and BP [ Time Frame: 48 hrs after starting study drug and for 48hrs after stopping study drug ]Changes in Heart Rate (HR) and BP for 48 hrs after starting study drug and for 48hrs after stopping study drug
- Cumulative Dose of Opioid and Benzodiazepine [ Time Frame: 2-4 weeks ]We will determine the total amount of opioid and benzodiazepine needed from the start of detoxification to the end of the the detoxification.
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| Ages Eligible for Study: | up to 90 Days (Child) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Criteria
Inclusion Criteria:
- >35 week Gestational Age (GA) at birth
- <3 months (90 days) old chronological age at the time of enrollment
- Exposed to a minimum five days of continuous narcotic infusion
Exclusion Criteria:
- Neurologic abnormality which would make Neonatal Abstinence Score (NAS) scoring inaccurate
- Major chromosomal abnormality (with the exception of Trisomy 21)
- Infant already enrolled in another randomized, controlled clinical trial
Information from the National Library of Medicine
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01360450
Locations
| United States, Maryland | |
| Johns Hopkins Hospital | |
| Baltimore, Maryland, United States, 21287 | |
Sponsors and Collaborators
Johns Hopkins University
National Institute on Drug Abuse (NIDA)
Investigators
| Principal Investigator: | Estelle B Gauda, MD | Johns Hopkins University |
Publications:
| Responsible Party: | Johns Hopkins University |
| ClinicalTrials.gov Identifier: | NCT01360450 History of Changes |
| Other Study ID Numbers: |
Clonidine NICU-NAS R21DA029295-01 ( U.S. NIH Grant/Contract ) |
| First Posted: | May 25, 2011 Key Record Dates |
| Results First Posted: | September 13, 2017 |
| Last Update Posted: | September 13, 2017 |
| Last Verified: | August 2017 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | No |
Keywords provided by Johns Hopkins University:
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opioid withdrawal Neonatal Pain, Agitation, and Sedation Scale (NPASS) duraclon |
Additional relevant MeSH terms:
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Neonatal Abstinence Syndrome Infant, Newborn, Diseases Substance-Related Disorders Chemically-Induced Disorders Mental Disorders Analgesics, Opioid Clonidine Narcotics Central Nervous System Depressants Physiological Effects of Drugs Analgesics |
Sensory System Agents Peripheral Nervous System Agents Antihypertensive Agents Sympatholytics Autonomic Agents Adrenergic alpha-2 Receptor Agonists Adrenergic alpha-Agonists Adrenergic Agonists Adrenergic Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action |