α2-Agonists
50. R.L.'s CRPS will be managed by a sympathoplegic agent. What doses of clonidine or prazosin will be required for pain management in R.L.?
The α2-agonists (e.g., clonidine) are useful in the management of SMP. They act by reversing the excessive sympathetic adrenergic response at central and peripheral receptors and by reversing local vasoconstriction with improvement in blood flow. Clonidine has analgesic effects when administered either systemically or locally at the spinal level. The α1-antagonist, prazosin, also has been used in the management of SMP. The dosages for clonidine and prazosin are 0.2 to 0.6 mg/day and 1 to 6 mg/day, respectively, in two to three equally divided doses. The major disadvantage of these agents is their side effects, especially hypotension and exacerbation of depression.162 In addition, rapid development of tachyphylaxis has been noted. Clonidine 0.1 mg orally four times daily would be a good starting dose for R.L., but the final dose must be titrated based on the patient's clinical response or side effects.
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