• Christophe Perruchoud, Michèle Bovy, Anne Durrer, Marilu Rosato, Blaise Rutschmann, Jean-Pierre Mustaki, and Eric Buchser.
• Department of Anaesthesiology and Pain Management, EHC, Hospital of Morges, Morges, Switzerland. christophe.perruchoud@chuv.ch
• Neuromodulation. 2012 Jan 1;15(1):31-4; discussion 34.

Background  Complications associated with intrathecal pumps may be linked to the surgical procedure, the implanted device, or the medication itself.Case Reports  Three patients treated chronically with intrathecal clonidine presented with clonidine overdose due to inadvertent extravasation during the refilling procedure. All patients experienced loss of consciousness and severe systemic hypertension that required aggressive parenteral treatment.Discussion  Clonidine is an alpha-2 agonist with a nearly 100% bioavailability after oral or rectal administration. With high plasma concentration secondary to massive systemic overdose, the specificity for the alpha-2 receptor is lost and an alpha-1 agonist activity predominates and causes marked hypertension. Management of clonidine overdose consists of supportive therapy guided by signs and symptoms.Conclusion  Inadvertent injection into the subcutaneous pocket rather than the reservoir is rare but very dangerous as the drug cannot be retrieved and massive doses are involved. Signs and symptoms of systemic overdose with drugs commonly used in implanted drugs delivery system should be well known to ensure early diagnosis and treatment.© 2011 International Neuromodulation Society.

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