{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:12:24Z","timestamp":1781647944492,"version":"3.54.5"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"3-4","license":[{"start":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T00:00:00Z","timestamp":1614297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,26]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Clonidine is a central alpha-2 agonist well known to produce a syndrome of bradycardia and hypotension in overdose. However, few examples of overt clinical clonidine toxicity secondary to cutaneous absorption have been reported. We report a case of unintentional systemic clonidine toxicity in an adult because of a compounded preparation of clonidine applied to a degraded skin barrier. A 35-year-old male suffered a motorcycle accident 48 hours before presentation resulting in an abrasion to his distal left leg. On the day of presentation, he self-treated the wound by repeated application of a family member\u2019s pain-relieving cream. Later he was found confused and unable to stand by a family member. The family member recognized the thick visible coat of cream as the likely cause and decontaminated the patient while calling 911. Prehospital vitals were notable for a blood pressure of 80\/30 mm Hg and heart rate of 38 beats per minute. In the emergency department, the patient was resuscitated with intravenous fluids with resultant normalization of blood pressure. Upon later review, the cream was determined to have been created by a local compounding pharmacy for the use in neuropathic pain and was labeled to contain clonidine, lidocaine, ketamine, and gabapentin. Cutaneous absorption of the pain cream was greatly increased because of loss of skin integrity. Military physicians and compounding pharmacies should ensure that patients are aware of the proper application of compounded creams and the potential risk for systemic toxicity with overuse or degraded skin.<\/jats:p>","DOI":"10.1093\/milmed\/usaa284","type":"journal-article","created":{"date-parts":[[2020,10,2]],"date-time":"2020-10-02T11:55:13Z","timestamp":1601639713000},"page":"e451-e453","source":"Crossref","is-referenced-by-count":5,"title":["\u201cRoad Rash\u201d and Dizziness: A Case of Hemodynamically Significant Topical Clonidine Toxicity"],"prefix":"10.1093","volume":"186","author":[{"suffix":"MC USA","given":"John W","family":"Downs","sequence":"first","affiliation":[{"name":"Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health Sys tem, Richmond, VA, 23219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"DO","given":"Kirk L","family":"Cumpston","sequence":"additional","affiliation":[{"name":"Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health Sys tem, Richmond, VA, 23219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,26]]},"reference":[{"issue":"2","key":"2021022616164207700_R1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.anclin.2017.01.009","article-title":"Alpha-2 Agonists","volume":"35","author":"Nguyen","year":"2017","journal-title":"Anesthesiol Clin"},{"issue":"10","key":"2021022616164207700_R2","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1080\/15563650.2018.1450986","article-title":"Naloxone reversal of clonidine toxicity: dose, dose, dose","volume":"56","author":"Seger","year":"2018","journal-title":"Clin Toxicol"},{"issue":"5","key":"2021022616164207700_R3","doi-asserted-by":"crossref","first-page":"309","DOI":"10.7326\/M18-2736","article-title":"Compounded topical pain creams to treat localized chronic pain: a randomized controlled trial","volume":"170","author":"Brutcher","year":"2019","journal-title":"Ann Intern Med"},{"issue":"5","key":"2021022616164207700_R4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/DER.0000000000000216","article-title":"Compounded topical analgesics for chronic pain","volume":"27","author":"Cline","year":"2016","journal-title":"Dermatitis"},{"issue":"3","key":"2021022616164207700_R5","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1067\/mpd.2001.111319","article-title":"Ophthalmic drops causing coma in an infant","volume":"138","author":"Berlin","year":"2001","journal-title":"J Pediatr"},{"issue":"10","key":"2021022616164207700_R6","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1136\/emj.2004.014795","article-title":"More than just an ocular solution","volume":"22","author":"Pekdemir","year":"2005","journal-title":"Emerg Med J"},{"issue":"11","key":"2021022616164207700_R7","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1097\/PEC.0b013e3182aa1384","article-title":"Can ophthalmic drops cause central nervous system depression and cardiogenic shock in infants?","volume":"29","author":"Kiryazov","year":"2013","journal-title":"Pediatr Emerg Care"},{"issue":"6","key":"2021022616164207700_R8","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1001\/jamadermatol.2017.0247","article-title":"Association of central nervous system depression with topical brimonidine when used for hemostasis: a serious adverse event","volume":"153","author":"Shagalov","year":"2017","journal-title":"JAMA Dermatol"},{"issue":"4","key":"2021022616164207700_R9","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1111\/pde.12868","article-title":"Brimonidine toxicity secondary to topical use for an ulcerated hemangioma","volume":"33","author":"Gill","year":"2016","journal-title":"Pediatr Dermatol"},{"issue":"1","key":"2021022616164207700_R10","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s13181-013-0331-x","article-title":"Dermal exposure to a compounded pain cream resulting in severely elevated clonidine concentration","volume":"10","author":"Pomerleau","year":"2014","journal-title":"J Med Toxicol"},{"issue":"11","key":"2021022616164207700_R11","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1097\/PEC.0b013e3182aa4748","article-title":"Compounded ointment results in severe toxicity in a pediatric patient","volume":"29","author":"Sullivan","year":"2013","journal-title":"Pediatr Emerg Care"},{"key":"2021022616164207700_R12","author":"U.S. Department of Justice","year":"2020"},{"key":"2021022616164207700_R13","article-title":"A Tennessee clinic swindled the military out of $65M. This is how it got caught","author":"Kelman","year":"2019","journal-title":"The Tennesseean"},{"issue":"9-10","key":"2021022616164207700_R14","doi-asserted-by":"crossref","first-page":"e330","DOI":"10.1093\/milmed\/usx200","article-title":"Prevalence of pain diagnoses and burden of pain among active duty soldiers, FY2012","volume":"183","author":"Reif","year":"2018","journal-title":"Mil Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/3-4\/e451\/36391288\/usaa284.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/3-4\/e451\/36391288\/usaa284.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T16:28:29Z","timestamp":1614356909000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/186\/3-4\/e451\/5909710"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,26]]},"references-count":14,"journal-issue":{"issue":"3-4","published-online":{"date-parts":[[2021,2,26]]},"published-print":{"date-parts":[[2021,2,26]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaa284","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2021,2,26]]}}}