Treatment of Alcohol Withdrawal Syndrome with and without Dexmedetomidine

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

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.

MeSH terms

  • Adult
  • Aged
  • Alcoholism / drug therapy*
  • Dexmedetomidine / administration & dosage*
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Patient Safety
  • Retrospective Studies
  • Substance Withdrawal Syndrome / drug therapy*
  • Substance Withdrawal Syndrome / physiopathology
  • Treatment Outcome

Substances

  • Dexmedetomidine