Observation and patient disposition after clonidine and guanfacine poisonings

Admit symptomatic patients with clonidine or guanfacine poisoning for observation until they are alert and able to walk safely without either significant postural hypotension or dizziness. For clonidine poisoning, this is generally within 48 hours following ingestionIsbister, 2017, but patients with guanfacine poisoning can have symptoms for up to 7 daysMishra, 2022. Bradycardia often persists for longer than 24 hours (eg up to 3 days for clonidine or 7 days for guanfacine), but is well tolerated and isolated bradycardia does not preclude dischargeIsbister, 2017.

Observe asymptomatic patients for at least 6 hours following clonidine poisoning and at least 12 hours following guanfacine poisoning.

If patients remain asymptomatic during this observation period, they can be discharged.

Discharge paediatric patients in daylight hours.

Sedative drugs can continue to cause significant cognitive impairment for several days following exposure. Advise patients not to drive or operate machinery for at least 3 days after dischargeDassanayake, Jones, , 2012 Dassanayake, Michie, , 2012.