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Perm J. 2016 Spring;20(2):49-53. doi: 10.7812/TPP/15-113.

Treatment of Alcohol Withdrawal Syndrome with and without Dexmedetomidine.

Author information

1
Internist at the Santa Clara Medical Center in CA. muna.a.beg@kp.org.
2
Pharmacist at the Santa Clara Medical Center in CA. sara.l.fisher@kp.org.
3
Pharmacist at the Santa Clara Medical Center in CA. dana.x.siu@kp.org.
4
Internist at the Santa Clara Medical Center in CA. sudhir.s.rajan@kp.org.
5
Pharmacist at the Santa Clara Medical Center in CA. E-mall: lawrence.troxell@kp.org.
6
Research Scientist in the Division of Research in Oakland, CA. vincent.x.liu@kp.org.

Abstract

CONTEXT:

Studies suggest that dexmedetomidine-an intravenous central-acting α2-adrenergic agonist that effectively reduces anxiety among critically ill patients-is being used in patients with severe alcohol withdrawal. However, evidence supporting its use is limited, and it is not approved for this indication.

OBJECTIVE:

To assess the effect of dexmedetomidine on severe alcohol withdrawal symptoms and to compare its use with benzodiazepines alone.

DESIGN:

A retrospective, cohort study of 77 patients admitted to the adult medical intensive care unit with severe alcohol withdrawal between January 1, 2009, and October 31, 2013.

MAIN OUTCOME MEASURES:

The difference in lorazepam equivalents and Clinical Institute Withdrawal Assessment for Alcohol scores in the 24 hours before and after initiation of dexmedetomidine therapy.

RESULTS:

The frequency of dexmedetomidine use increased dramatically between 2009 and 2013 (16.7% vs 82.4%; p = 0.01). Initiation of dexmedetomidine therapy was associated with significant improvements in Clinical Institute Withdrawal Assessment for Alcohol scores over corresponding 24-hour intervals (14.5 vs 8.5; p < 0.01). Benzodiazepine use also decreased, but the difference was not statistically significant at 24 hours (p = 0.10). Dexmedetomidine was well tolerated, requiring discontinuation of therapy in only 4 patients (10.5%). Dexmedetomidine use was also associated with significantly longer hospitalizations (p < 0.01).

CONCLUSION:

Dexmedetomidine initiation was associated with a reduction in short-term alcohol withdrawal symptoms in patients in the intensive care unit, with only a few patients experiencing adverse events. However, its use was also associated with longer hospitalizations. Further research is necessary to evaluate whether dexmedetomidine is efficacious or cost-effective in severe alcohol withdrawal.

PMID:
27168398
PMCID:
PMC4867825
DOI:
10.7812/TPP/15-113
[Indexed for MEDLINE]
Free PMC Article

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