Evaluation of Early Dexmedetomidine Addition to the Standard of Care for Severe Alcohol Withdrawal in the ICU: A Retrospective Controlled Cohort Study

J Intensive Care Med. 2016 Mar;31(3):198-204. doi: 10.1177/0885066614554908. Epub 2014 Oct 16.


Purpose: This study evaluated the impact of dexmedetomidine (DEX) administration on benzodiazepine (BZD) requirements in intensive care unit (ICU) patients experiencing alcohol withdrawal syndrome (AWS).

Methods: This trial included adults admitted to the ICU for >24 hours for AWS. Early DEX was defined as receiving DEX within 60 hours of hospital admission. The primary outcome was 12-hour BZD requirement from the inflection point or DEX initiation. Secondary outcomes included 24-hour BZD requirements, symptom control, ICU and hospital length of stay, and incidence and duration of mechanical ventilation. Safety outcomes included incidence of bradycardia and hypotension.

Results: Twenty patients receiving DEX were matched to 22 control patients. The mean 12-hour change in BZD requirement was significantly different for DEX versus control (-20 vs -8.3 mg, P = .0455) with a trend toward significance at 24 hours (-29.6 vs -11 mg, P = .06). No significant differences were noted in other secondary outcomes. Patients receiving DEX experienced significantly more bradycardia than controls (35% vs 0%, P < .01) but not hypotension.

Conclusions: This study suggests DEX is associated with a reduction in BZD requirement when utilized as adjunctive therapy for AWS. A larger prospective trial is needed to evaluate the clinical impact of DEX for AWS.

Keywords: alcohol withdrawal; benzodiazepines; critical illness; dexmedetomidine.

MeSH terms

  • Adult
  • Aged
  • Benzodiazepines / administration & dosage*
  • Bradycardia / chemically induced
  • Case-Control Studies
  • Chemotherapy, Adjuvant
  • Colorado / epidemiology
  • Critical Care / methods*
  • Dexmedetomidine / administration & dosage*
  • Drug Administration Schedule
  • Ethanol / adverse effects*
  • Female
  • Humans
  • Hypotension / chemically induced
  • Intensive Care Units
  • Length of Stay
  • Male
  • Middle Aged
  • Respiration, Artificial
  • Retrospective Studies
  • Standard of Care
  • Substance Withdrawal Syndrome / drug therapy*
  • Treatment Outcome


  • Benzodiazepines
  • Ethanol
  • Dexmedetomidine