September 13, 2010

What is Clonidine?

Posted: 10:12 AM ET

Brockton, MA - According to three of the four medical experts who testified during Michael Riley’s murder trial, four-year-old Rebecca Riley’s death was either directly due to the effects of the prescription drug clonidine, or clonidine was a contributing factor in her demise.  But what exactly is clonidine?  And what effect could it potentially have on a child of Rebecca’s age?

Sometimes known by the brand names Catapres and Duraclon, clonidine was originally approved by the U.S. Food and Drug Administration as a medication to treat hypertension in adults.  But over the years it has also come to be prescribed to treat several other medical and psychiatric conditions – a practice that is commonly known as “off-label” use, and not officially sanctioned by the FDA – including insomnia, Tourette’s syndrome, post traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD).

Rebecca Riley first began taking clonidine in 2004 – she was only two at the time – when Dr. Kayoko Kifuji prescribed it after diagnosing Rebecca with ADHD.  But clonidine use in adolescents is a gray area, since no comprehensive studies of the drug’s potential long term effects in children have ever been conducted.  The problem with clinical drug studies of children is one of ethics; since children aren’t able to give informed consent to the possibility of potentially dangerous side effects associated with drug testing, it’s considered unethical to use them as study subjects.

What did all that mean for Rebecca Riley?  It means that she was regularly ingesting large amounts of a prescription medication that wasn’t designed for use in children, and that she was taking it to improve a condition that the FDA hasn’t approved clonidine to treat.               

-Michael Christian, In Session Field Producer

Filed under: Trials

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Andria M. Simpson   September 13th, 2010 10:18 am ET

I have dispensed this medication and other controlled substances at my previous job, a group home for adults and teens diagnosed with mental retardation, developmental disabilities, learning disabilities, and mental illness or a combination of any one of those diagnosis. I had one person who was in his late teens and was diagnosed with several different dx.

One important aspect of any psychotropics, or controlled meds, is that they are SUPPOSED to be strictly monitored including routine vitals taken, routine blood work, routine appts with the prescribing MD, or Psychiatrist.

Karen Sanders   September 13th, 2010 11:10 am ET

My son has been taking clonidine for the past 3 years as a part of his treatment for ADHD. Up until he was 12 years old he had NEVER slept through the night. I thought it was unusual to give a child medication for high blood pressure to get him to sleep, but the benefit of a full night's sleep has far out-weighed any concerns I had. At this time he is 15 years old, 112 lbs and is only taking 0.1mg.

I'm not as concerned with WHAT medication this little girl was given but how it was managed by her parents. Ultimately, it is the parents responsibility.

Coleen   September 13th, 2010 11:16 am ET

2 years old people! 2 years old! There is no way in this world that any doctor can diagnose a 2 year old with ADHD or Bipolar Disorder. This doctor should have her license taken away. She was participating in a scam to get SSI benefits, there is no other reason (except incompetence) that this diagnosis could be made.

To prescribe this very strong medication to a child of two is unconscionable. I know adults who have a hard time handling this medication. Children have no voice and adults who abuse that fact should be punished severely. It's clear the doctor abused her privilege and after seeing the trial the father is at fault as well.

This child was let down by CPS. Even if they couldn't second guess the doctor on the medication they could certainly show that she was overmedicated – there were enough people around to testify to it.

phoebe sigmon   September 13th, 2010 11:54 am ET

i truely don't understand why the mother, school nurse, teacher, and doctor/s haven't been charged for this crime also. they are all just as guilty for this little girls death. the school nurse and teacher should have reported this to child protective services. the doctor should have put the little girl in the hospital and ran tests and had her observed.
and the mother, why didn't she take her children and leave if she wasn't in on what he was doing to get ssi for her?

janice   September 13th, 2010 11:56 am ET

i don't think that it matters whether or not the father gave the pills or not, he had to have seen how ill this child was and did nothing about it. The child was too young to make decisions for herself and needed an advocate. I feel he is at least guilty of neglect.

Diane   September 13th, 2010 12:04 pm ET

Clonodine for a 2 year old? Weird.

cheryl a. townsend   September 13th, 2010 12:48 pm ET

I find this trial to painful to watch..everyone abandoned their fundamental duty to this sweet. child. This child died from a chronic oversedation and a slow poisoning. This child could not at times hold her head upright, sit upright, walk up and down steps. If she was eating being so sedate, this little girl was chronically and silently aspirating food and her own secretions. Why she developed pneumonia!
The suffering of this child was cruel and so many so called professionals assisted because they were cowards..standing by and doing to little, to late...slow suffocation, drowning from cardio/pulmonary failure...everyones' worst nightmare when they are faced with their own mortality..unnessary suffering

Debbie Marie   September 13th, 2010 1:04 pm ET

This child was described as lethargic, no affect, could not hold herself up in a chair, and didn't even have the strength to use the restroom. Yet day after day, she was taken to the school nurse. Why wasn't Chilid Protective Services called early on? The ongoing condition of this little girl required well beyond daily visits to the school nurse.

Eve   September 13th, 2010 1:11 pm ET

18 month old not cleaning her room! The audacity! Really? Are they kidding us? What about their home. From photos I have seen in this case the floor where this child died was littered. Who knows when it was last cleaned. Are they serious? To me, this corks the bottle. This is a little girl to whom no more harm can come. May her past tears see justice.

Debi Butler   September 13th, 2010 1:59 pm ET

I am disgusted with these parents. I am a nurse and a mother of three. One of my children has ADHD. These parents CAN find information. They can easily seek out professional opinions. Information that is given to families is on an 8th grade level. It is done this way so it can be understood. Packages from the pharmacy have information. The pharmacist will answer questions. The systems are in place. These teachers and service agencies are not parents and while they are there to assist they are not responsible. The responsibility lies with these parents. I hope he is imprisoned and that the other children are safe.

That is one of problems with this entire society. WE are responsible for our childrens welfare. Period. These people are an argument for birth control.

Joe Matthews   September 13th, 2010 2:56 pm ET

If I was on that jury, i would want to hear from the Mother of Rebecca, and if she did not appear at the trial, it would leave me wondering why she was not called as a witness. I would also like to know if the other 2 children have had their medications changed since they are no longer in their parents custody.

james   September 13th, 2010 3:09 pm ET

Regardless of their awful parenting, this should be a manslaughter trial, not 1st degree murder. The parents didnt forge prescriptions, the doctor wrote them for the child.
Being a couple of lousy, welfare parents scamming the system is the reason the mother got convicted for murder. This is the kind of witch hunt the public loves. The prosecution knew any jury would hate these people for being lowlifes and it would be an easy murder conviction.

Denise   September 13th, 2010 3:15 pm ET

My now 18 year old son was put on clonidine when he was 2 yrs old. He is A.D.H.D with Oppositional Defiant Disorder. He would go days without sleeping. My husband and I took turns staying up with him. The clonidine gave him about 5 hours sleep per night. He was monitored monthly. So, I would have to say that it is not uncommon for very young children to be prescribed clonidine. At age 6, my son told me that he didn't like the way it made him feel when he woke in the morning so I stopped it! We went back to days of no sleep and then crashing for 14-18 hours. He is the 3rd child of 4. We all learned to ride this crazy wave of his and continue to do so. This young man is currently taking college classes online. His major is Media Arts and Animation. This works for him and his wild schedule.

I find it hard to believe that no one could see what this medication was doing to this child and they all FAILED to act. Everyone involved in this child's life is to blame for her death.

Regina   September 13th, 2010 3:29 pm ET

Knowing that both parents were unemployed and receiving disability checks, I am sure that the whole family was covered by Medicaid. Medicaid pays ALL medical expenses for qualified persons. I have heard over and over again that the dad was so concerned for Rebecca that he drove to three pharmacies to buy OTC cough medicine for her. Ok...My question/comment is why would the dad waste gas to drive to three different locations for OTC medicine that he would have to pay for out of pocket when Medicaid would 1. Pay for the doctor visit 2. Pay for all prescriptions needed. I really dont think he wanted to kill her, because after all, he viewed her as a potential paycheck.

As I type this, I wonder if there is anyone in the Medicaid system that reviews or monitors medications that are being dispensed. I take Ambien for sleep and last month my insurance company said that they would only pay for a 30 day supply every 90 days unless they received a note from my doctor. Hmmmm...I kind of thought that is what a PRESCRIPTION was, but nonetheless it just made me wonder if there is anyone behind the scenes looking into all of this free medicine that is distributed...

Rebecca   September 13th, 2010 3:30 pm ET

I am a psychiatric RN and a mother of a child with autism. My son is unable to sleep for more than a couple hours at a time. After trying melatonin my pediatrician suggested Clonidine. This has been wonderful for my son who takes it in the evening and sleeps about 6-8 hours after taking it. My son is 6 years old and takes 0.05 mg daily. This poor child took 0.35 mg- this is 7 TIMES the dose my son takes. Even when I have given this medication to adults in the psychiatric setting the usual dose for an adult is 0.10 mg. I have patients on less medication then that child. She had to be a walking zombie. My point is that is medication is very valuable to people who truly need it when used properly. It wasn't the medication that killed her- it was the parents and the doctors.

Yieldcurve   September 13th, 2010 3:51 pm ET

Has the doctor – Dr. Kayoko Kifuji – been charged for off-label use of the clonidine? He certainly ought to be. Is he still practicing medicine?

Also, where are the other children? Are they still taking all of the meds Dr. Kayoko Kifuji has prescribed? Have the children been given counseling over the death of their sister and their parents involvement with her death?

deana   September 13th, 2010 5:49 pm ET

my son has been taking this med for about a yr now. if he doesnt take it,he gets no sleep.his mind races and this is the only thing that allows him to get proper sleep for school etc. hes 6yrs we go see his dr every three son also takes 0.1mg and its a big help. sorry to the family,but all meds hav effects,and we as adults need to b paying more attention to our kids when these type of meds r givin.

David Arakelian   September 13th, 2010 6:02 pm ET

I am originally from the Boston area. (We currently live in North Idaho). Here's my question about this case. Under Mass. case law, could the father be guilty by "omission", as opposed to being guilty by "commission"? While I am not sure that the evidence indicates that he ever directly put any of the medication in Rebbecca's mouth, I do believe that he knew what was going on. Therefore, in my mind, he is guilty by association, even if he was not the principal in this case.

Leslie Dorman   September 13th, 2010 8:22 pm ET

This all could have been prevented had the school nurse/ Principle called 911 when they saw that Rebecca wasunresponsive, unable to walk or sit up. If a child is that unresponsive it is a schools responsibility to seek Emergency Medical Treatment.

She would have been taken to the ER, where the doctors would have observed the clear fact of medication abuse. The teachers also should have told CPS about her frequent urination and concern of UTI.
(It is almost unheard of that if a father is molesting one child , that he is not sexually abusing all of his children.)

Once again a child falls through the cracks and it breaks my heart.

Jessica Nashville   September 14th, 2010 12:26 am ET

I would like to leave a comment on the Rebecca Riley case. I beleive that if the parents thought it was important enough to take the little girl to a Doctor to have her put on ADHD meds, then why wasn't it important enough to take her if she was sick. Answer: There was no check involved!!! These people, and thousands of others like them have played this system for years, generation, after generation, the only difference is that they actually got caught. They are the reason why it is so difficult for truly disabled people to get the help that they need. They should be held accountable for thier actions, however if the Doctor had never given them the medications that made thier little girl sick in the first place, none of this would have ever happened. Cause and Effect!

courtney   September 14th, 2010 2:46 am ET

ADHD drugs to a 2 year old!!! Shame on the parents and the doctor, they are all responsible for her death! I dragged my youngest from doctor to doctor to find out why he was so "energetic", and finally talked to the local ADHD doctor, explained all my efforts, only for him to tell me that I was my child's best option in tracking any other solutions down. He said that all he did was follow a criteria and if you answered 'yes' enough, he would be diagnosed as ADHD. Excuse me? Long story short, he was allergic to milk, it made him hyper, allergy tested him (avoided milk) and on day 3 it was like someone turned the energy dial down.

Drugging a two year old! Will the justice system actually do something for a change?

warsteiner   September 14th, 2010 7:42 am ET

This drug is a Benzo like valumm, zanax, It can be prescribed for stress but also TMJ or nerve damage. Heroin addicts on methadone take Benzo's because it enhances the effects of the Methadone. Problem is that detoxing off benzo's is as bad as herion and can kill you if you go cold turkey. It would have been a semi comfortable way for the child to go she would fall asleep and die.

Sharon   September 14th, 2010 11:09 am ET

My question was how was so much clonidine obtained by this family? In Massachusetts when you have a prescription written for 30 days, you can NOT refill it before the 30 days without the pharmacist getting another prescription from your Dr. So in my opinion, this Dr. knew exactly how much these parents were giving to Rebecca because the Dr. had to ok the increase and write a subsequent prescription. Why isn't the pharmacist and all of these prescriptions introduced into this trial? Both the DR. and the Pharmacy knew that Rebecca was being overmedicated.

Tracie   September 14th, 2010 12:15 pm ET

I know that the other people in the home struggled with what they felt they could do to help this little girl. Couldn't they call 911 to get emergency responders to come out to the home? At the very least, they could look her over and determine whether or not she needed immediate medical attention.

Jennifer   September 14th, 2010 2:17 pm ET

My 9 year old daughter takes this medication to help calm her and to sleep. Her doctor told me that if this doesn't work they would have to find something else because it would be lethal to give her a high dose than .25 now how could another doctor give this child that much medication and no one call dss i mean come on.

Cherie   September 14th, 2010 2:51 pm ET

This could have been avoided. If the parents refused to take the child to Doctors but to social security instead. Why didn't anyone call child protective services to have them see the child at SS office? That is the one question I would be asking over and over. But than again most people would call 911.

Lillian   September 14th, 2010 10:48 pm ET

This child wasn't just failed by her parents and the "system"..she was failed by her school, her doctor, the pharmacy filling the prescriptions, an uncle and God only knows how many others!

The teaches told how this child could barely hold her head up....the school nurse saw this child on a regular basis, the doctor saw her, the nurse in the doctors office saw her, her uncle saw her.....not one of these people did anything to rescue this child from a deplorable situation!

She was nothing more than a "meal ticket" for everyone who ever interacted with her: her parents, the school teachers, the school nurse, the doctor and everyone who worked in the doctors office...the pharmacist who filled those bottles time and time again...all were just "doing their jobs"...and getting paid..while an innocent child died a little at a time! Shame on all of them!

Amelia   September 15th, 2010 10:49 am ET

I would figure that this doctor would have kept a closer eye on her progress on this medication. She just seems like one of theose doctors that are prescription pad happy. She should have done more check-up appointments to keep up with the progress of a small minor like that.

Susanne   September 15th, 2010 11:17 am ET

I am sickened by the testimony of her doctor. Parents beware of doctors who easily prescribe medications to young children. This doctor observed the child as unconscious in her office but still continued to prescribe the clonidine. Physical assessment challenged the mothers claims of the child still not sleeping. The ball was dropped when the doctor gave in to the mothers wants. The mother bullied the doctor. The doctor knew the dose was too high from the start. She should have cut her off. I am sure the pharmacy called the doctor to verify the dosage. The doctor said it was ok. The pharmacist could refuse to fill it at that point. But these parents would find a pharmacy to fill it with the doctors blessing. I can tell you the doctor thought her worst nightmare was that the parents followed her to her new job. We know now she has to live with the direct responsibility of the death of this child. She can testify that
She would not change a thing in this case. We all know that she would.
I'm. Sure a day does not pass without her thinking about this child.

Patty Bulger   September 15th, 2010 12:14 pm ET

I have been on clonidine for high blood pressure for a year.I cannot tell you the powerful affect it has on me.I take 1 mg when my blood pressure goes over 160/90.It wipes me out. Can't imagine a two year old being anything but comotose from it.I have to lie down for a couple of hours.
The Dr is incompetent and the parents felons-using her as a cash cow.

Julie A. Grogan   September 15th, 2010 2:53 pm ET

I am also wondering what happened to bubble bathes with toys, reading stories or singing lullabyes.

I must disagree with the pharmacist's statements that Clonidine is rarely prescribed with the other listed medications. There are facilities all over our country full of children of various ages that are prescribed Clonidine with and without Depakote, Trileptal, Tegretol, Seroquel, Zyprexa, Topamax, Thorazine and a host of other psychotropic medications.

It is not possible to diagnose a 2 year old with ADHD or Bipolar Disorder.

The psychiatrist is primarily responsible for intensive education regarding the use and/or misuse of psychotropic medications. This physician obviously did not collaborate with other healthcare professionals involved in the child's care to provide appropriate medication management.

Rebecca Harden   September 15th, 2010 3:01 pm ET

My daughter has been on clonidine 0.1 mg since aug 2008 and has no problems with it. She was 5 then now she is 8. I cant believe a dr would put a 2 yr old on this. I cant believe the pharmasist didnt question this. they usually dont feel prescriptions less then 30 days. She was on way to many meds to begin with. There was signs before her death and that should of been investaged....this is a shame. She had to lose her life because of all the irresponsibility of the parents and dr....R.I.P. Rebecca

Erica   September 15th, 2010 3:36 pm ET

People today are sick. If their child does not behave exactly the way they want them to, they run to the doctor to drug them. And these doctors give in to them! So a 2-year-old is hyper. Wow, that's a shocker. They don't want to sleep. What child does? So if your child sleeps too much, sleeps too little, talks too much, talks too little, eats too much, eats too little – let's drug them up! I could have cried when I saw that the doctor's notes said that the child "talks a lot". I have an autistic daughter who can barely communicate. I would give anything to have that complaint. Oh, and by the way, she was hyper, she didn't like to sleep, AND I DIDN'T FORCE POISON DOWN HER THROAT TO MAKE MY LIFE EASIER! She changes as the years go by, and I thank God that I'm not stupid enough to force pills down her throat today that may hurt her later.

Candy palmdale ca.   September 15th, 2010 5:45 pm ET

I am ashamed for the Dr.parents family , friends and/ school it makes me sad to hear the Doctor talk like it not nothing a child lost her life you act like you did nothing wrong .Gods going to get them,one more thing the pharmacy has some blame too.

kimee   September 15th, 2010 7:22 pm ET

The next obvious question is were the parents taking these drugs too??

kim   September 15th, 2010 10:09 pm ET

I have 3 children. The middle child, a boy, is borderline mentally retarded. He was diagnosed with ADHD in the 1st grade. The teachers wanted me to have him put on Ritalin. I took him to the doc., and the doc. took one look at me and said no. He assumed that I wanted it for myself. He asked me if I knew what Ritalin was, and I told him no, but I had heard from a lot of people not to allow anyone to put my son on it. When I asked the doc. what he wanted me to tell the school as to why he wouldn't prescribe Ritalin for my son, he decided to prescribe Dexedrine for him. My son already received SSI for being borderline mentally retarded, but it was the school that wanted him on meds, not I. As a matter of fact, my boys were taken away from me because I couldn't get my son's meds, and I did what I was supposed to do. Why didn't anyone call DHS on these people? I think people are being over diagnosed because noone wants to deal with them. And everyone is to blame. Unless the parents went to different pharmacies so as not to arouse suspicion, the pharmacy should be closed down, and never allowed to reopen. The doc. needs to have her head examined, and I'm not going to say what else needs to be done. And that goes for the parents as well.

Marie Martin   September 16th, 2010 10:41 am ET

I am just beside myself with anger at both the attending Physician, and Rebecca's parents. Clearly none of the above cared enough to do the very best for any of those children. I had a very similar experience with my niece many years ago. She, "mary", was adhd, whiney, and downright nasty. Just basically a miserable child to handle or to be around. Her mother and I would literally take turns staying up with the Mary because she only slept, fitfully, approximately 2 out of a 24 hour period. Mary's mother was prompted by her pediatrician, to attend a short series of , "Behavior Modification", classes, which literally taught us how to interact a child, {so that she understood fully what/why she was being addressed}. AND a VERY STRICT DIET, of all natural foods, {ie dyes, preservatives...}, and reduced sugar. That even went as far as the toothpaste used. Within a relatively short period of time, life was good. I raised my children in the same way, and, I'm proud to say, rarely ever had a problem with either of them. They Graduated with honors, and are now living productive lives.

Smills   September 16th, 2010 11:10 am ET

Clonidine & Seroquil? i know grown adults who take "small" doses of these medications who can't function, as a mother of a child with ADHD & other conditions I could never under any circumstances justify giving that to my 2 yr old child they should all have been arrested.

Greg   September 16th, 2010 2:08 pm ET

A 2 year old diagnosed with ADHD? That is wrong. You cannot diagnose a 2 year old with ADHD. The doctor should lose his license and be sent to prison.

nancy p*   September 17th, 2010 6:23 pm ET

This is whats wrong with some parents today.
if the kid makes noise,, pop a pill
if the child runs around and acts like a child.. pop a pill
its a quick fix for parents not to be behaving like parents,,, all kids want to do is act like kids not to be medicated alll the time,,,,, these doctors that prescribed these medications should be on trial as well,

omg this poor little girl,, for a little person to take these pills , its insane,,,,,,,,,
some medications keep a child up all night,,,,,,, if taken in high dosages,,,, some makes a kid sleep,,,, if taken in high dosages,,

its totally ludicrious for kids to be taking pills,, just let them be kids

thank you and have a nice evening morning or day

and stop the madness already,, the pill pushing, on these young kids,,,

mela50   September 17th, 2010 11:42 pm ET

dr Kifuji ! Are you kidding me! She allowed the mother to increase Rebecca's medication! Who is the real doctor? Because Dr.Kifuji is a joke to be called a DOCTOR OF ANY KIND!!!!!!!!!!!!

Kris   September 18th, 2010 1:46 am ET

I can believe anything anymore. My bonus son that I have been raising for 9 years was given drugs for a condidtion he did not have, schizophrenia, by a doctor in Walnut Creek, CA, over the phone, without ever seeing the child!!!
The drug was Risperdal and it can permanently affect brain chemistry in the adults it is usually given to as a last chance to help them..a very dangerous drug.
This doctor gave this to a child, 9 YEARS OLD...without ever seeing him!! His mother was a diagnosed borderline personality disorder and the family court system here in Contra Costa County did NOTHING to protect this child for her delusions that he was ill.
These psychiatric doctors are out of control and are further abusing children everyday in every city in this country!!
Parents need to wake up and protect their children from the doctors that were suppose to help families.

Kris   September 18th, 2010 1:50 am ET

These parents were after the money from Social Security also. They tried to damage their child so they could get money from the state.
How horrible is that, hurt your child and get money....make him ill and get money. They should be locked up and the doctor should be prosecuted to the full extent of the law.

Linda Stomberg   September 18th, 2010 6:46 pm ET

I have hypertension, alcohol addiction, and sleep disorder. When I went into rehab they prescribed me .3 mg tid. Oh I slept great , but I could not function during the day. I staggered around all day, got so exhausted from physical exertion, ( just trying to make it from place to place) and had to stop frequently to catch my breath). I'm 5'4" 132lbs. How could any doctor let a frail little girl take this?

beverly   October 18th, 2010 1:36 am ET

i can not understand any doctor putting a 2 year old on medication for ADHD-my 2 year old granddaughter has been put on this clodine and by her other grandmother because she has temp. coustody -what can i as the other blood grandmother do to get my grandbaby off this drug?? to top that off she is given meds to wake her up in the mornings-I NEED HELP AND ADVICE on what i can do===i am at my wits end because i don't have or see anything wrong with this child except she is simply a two year old child who loves to play play –like my own kids at her age

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