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Dexmedetomidine Infusion as Adjunctive Therapy to Benzodiazepines for Acute Alcohol Withdrawal

Fellow, Pulmonary and Critical Care Medicine Division, Cooper University Hospital, Camden, NJ

Nitin Puri, MD

Fellow, Critical Care Medicine, Cooper University Hospital

Erin Prince, DO

Resident, Emergency Medicine Division, Cooper University Hospital

Anthony Lomonaco, DO

Resident, Anesthesiology Division, Cooper University Hospital

Antoinette Spevetz, MD FCCM FACP

Associate Professor of Medicine; Associate Director, Internal Medicine Residency Program, Section of Critical Care Medicine, Cooper University Hospital

David R Gerber, DO FCCP

Associate Professor of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden; Associate Director, Medical–Surgical Intensive Care Unit, Cooper University Hospital

Reprints: Dr. Darrouj, 7 MacArthur Blvd., Apt.# 408, Collingswood, NJ 08108, fax 856/541-3968, jdarrouj{at}yahoo.com

OBJECTIVE: To report a case of alcohol withdrawal and delirium tremens successfully treated with adjunctive dexmedetomidine.

CASE SUMMARY: A 30-year-old man with a history of alcohol abuse was admitted to the general medical unit because of altered mental status and agitation. He was initially treated for alcohol withdrawal with benzodiazepines; his condition then deteriorated and he was transferred to the intensive care unit. Because of the patient's poor response to benzodiazepines (oxazepam and lorazepam, with midazolam the last one used), intravenous dexmedetomidine was started at an initial dose of 0.2 µg/kg/h and titrated to 0.7 µg/kg/h to the patient's comfort. Midazolam was subsequently tapered to discontinuation due to excessive sedation. In the intensive care unit, the patient's symptoms remained controlled with use of dexmedetomidine alone. He remained in the intensive care unit for 40 hours; dexmedetomidine was then tapered to discontinuation and the patient was transferred back to the general medical unit on oral oxazepam and thiamine, which had been started in the emergency department. He was discharged after 5 days.

DISCUSSION: A review of the PubMed database (1989–2007) failed to identify any other instances of dexmedetomidine having been used as the principal agent to treat alcohol withdrawal. The use of sedative to treat delirium tremens is well documented, with benzodiazepines being the agents of choice. The clinical utility of benzodiazepines is limited by their stimulation of the -aminobutyric acid receptors, an effect not shared by dexmedetomidine, a central ₂-receptor agonist that induces a state of cooperative sedation and does not suppress respiratory drive.

CONCLUSIONS: In patients with delirium tremens, dexmedetomidine should be considered as an option for primary treatment. This case illustrates the need for further studies to investigate other potential uses for dexmedetomidine.

Key Words: alcohol withdrawal, delirium tremens, dexmedetomidine

Published Online, September 9, 2008. www.theannals.com, DOI 10.1345/aph.1K678

This article has been cited by other articles:

				A. Gupta, D. Lee, and M. Su Comparing Dexmedetomidine With Midazolam for Sedation of Patients in the ICU JAMA, June 17, 2009; 301(23): 2440 - 2441. [Full Text] [PDF]