Muna Beg1, Sara Fisher2, Dana Siu3, Sudhir Rajan4, Lawrence Troxell5, Vincent X Liu6. 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.
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.
Authors: Erin N Frazee; Heather A Personett; Jonathan G Leung; Sarah Nelson; Ross A Dierkhising; Philippe R Bauer Journal: J Crit Care Date: 2013-11-23 Impact factor: 3.425
Authors: Pratik P Pandharipande; Brenda T Pun; Daniel L Herr; Mervyn Maze; Timothy D Girard; Russell R Miller; Ayumi K Shintani; Jennifer L Thompson; James C Jackson; Stephen A Deppen; Renee A Stiles; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: JAMA Date: 2007-12-12 Impact factor: 56.272
Authors: Juliana Barr; Gilles L Fraser; Kathleen Puntillo; E Wesley Ely; Céline Gélinas; Joseph F Dasta; Judy E Davidson; John W Devlin; John P Kress; Aaron M Joffe; Douglas B Coursin; Daniel L Herr; Avery Tung; Bryce R H Robinson; Dorrie K Fontaine; Michael A Ramsay; Richard R Riker; Curtis N Sessler; Brenda Pun; Yoanna Skrobik; Roman Jaeschke Journal: Crit Care Med Date: 2013-01 Impact factor: 7.598
Authors: Samuel G Rayner; Craig R Weinert; Helen Peng; Stacy Jepsen; Alain F Broccard Journal: Ann Intensive Care Date: 2012-05-23 Impact factor: 6.925
Authors: Joshua T Smith; Mary Sage; Herb Szeto; Laura C Myers; Yun Lu; Adriana Martinez; Patricia Kipnis; Vincent X Liu Journal: JAMA Netw Open Date: 2022-02-01
Authors: Tessa L Steel; Majid Afshar; Scott Edwards; Sarah E Jolley; Christine Timko; Brendan J Clark; Ivor S Douglas; Amy L Dzierba; Hayley B Gershengorn; Nicholas W Gilpin; Dwayne W Godwin; Catherine L Hough; José R Maldonado; Anuj B Mehta; Lewis S Nelson; Mayur B Patel; Darius A Rastegar; Joanna L Stollings; Boris Tabakoff; Judith A Tate; Adrian Wong; Ellen L Burnham Journal: Am J Respir Crit Care Med Date: 2021-10-01 Impact factor: 21.405