Elsevier

General Hospital Psychiatry

Volume 28, Issue 4, July–August 2006, Pages 362-363
General Hospital Psychiatry

Case Report
Dexmedetomidine as an adjuvant in the treatment of alcohol withdrawal delirium: a case report

https://doi.org/10.1016/j.genhosppsych.2006.03.002Get rights and content

Abstract

In this case report, even a moderate dose of dexmedetomidine, a very selective α2-adrenergic agent, resulted in a rapid response to alcohol withdrawal delirium after the standard treatment. Psychiatrists should be aware of this relatively new drug that provides advantages over clonidine, heavy sedation and secondary restraints. Dexmedetomidine should be further evaluated in the treatment of specific forms of aggressive behavior and complicated withdrawal states.

Introduction

Dexmedetomidine, a very selective α2-adrenergic agonist, has sedative, analgesic, anxiolytic and sympatholytic effects mediated via central receptors, with a predictable hemodynamic profile and without inducing significant respiratory depression [1], [2]. The half-life of dexmedetomidine is only 2 to 3 h, shorter than that of clonidine, which makes it relatively easy and safe to titrate by continuous intravenous infusion. Dexmedetomidine alleviates the ethanol withdrawal symptoms in rats [3] and has shown some neuroprotective effects [4]. Dexmedetomidine has been used recently in cases of opioid and benzodiazepine withdrawal [5]. We report a clinical case of a complicated alcohol withdrawal delirium in which dexmedetomidine was used as an adjuvant.

Section snippets

Case report

A 50-year-old male was admitted to a referral center because of severe delirium and violent behavior. His past medical history was significant for severe alcohol dependence, without other drug abuse, and hypertension, which was medicated properly by candesartan 18 mg a day. He had been hospitalized over 10 times during the last 15 years in a psychiatric department for 3 to 5 days' periods because of alcohol-induced hallucinations and alcohol withdrawal delirium; the last of those had occurred

Discussion

In this case, even a low dose of dexmedetomidine added on the standard treatment resulted in a rapid and successful response to complicated alcohol withdrawal delirium. Previous case reports have concentrated more on opiate, benzodiazepine and polysubstance withdrawals [5], [6]. On the ground of this case, practice guidelines cannot be outlined, but the clinical experience opens prospects for the use of dexmedetomidine as an adjuvant in the treatment of complicated alcohol withdrawal delirium,

References (6)

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