title: Dexmedetomidine for Alcohol Withdrawal Syndrome.
abstract: OBJECTIVE
  To review available evidence evaluating dexmedetomidine in alcohol withdrawal syndrome (AWS) while identifying gaps in evidence for its use in this setting.
  
  
  METHODS
  A MEDLINE search (1966-August 2015) to identify English-language articles evaluating the efficacy and safety of dexmedetomidine in alcohol withdrawal. Key words included alcohol, withdrawal, delirium tremens, and dexmedetomidine. Additional references were identified from a review of literature citations.
  
  
  METHODS
  All English-language observational studies, retrospective reviews, and clinical trials were included. Case reports and case series describing the use of dexmedetomidine in 10 or fewer patients were excluded.
  
  
  RESULTS
  One randomized, controlled trial, 1 prospective observational study, and 6 retrospective reviews were identified. The only randomized, controlled trial identified showed that the addition of dexmedetomidine decreases benzodiazepine requirements more than placebo in the first 24 hours after initiation compared with the 24 hours prior to initiation (-56.8 mg vs -8 mg; P = 0.037). Overall, dexmedetomidine appears to lower benzodiazepine requirements in patients with AWS and decreases the sympathomimetic response seen in these patients. There was no convincing evidence that dexmedetomidine improves clinical endpoints in patients with AWS, such as need for mechanical ventilation or intensive care unit or hospital length of stay.
  
  
  CONCLUSIONS
  Dexmedetomidine reduces hypertension and tachycardia in AWS and also reduces benzodiazepine requirements; however, the impact of these findings on important clinical endpoints is yet to be determined. Dexmedetomidine may be useful as adjunctive therapy; however, it cannot be recommended as a single agent in the management of AWS.
authors.affiliation: Manchester University College of Pharmacy, Fort Wayne, IN, USA Parkview Regional Medical Center, Fort Wayne, IN, USA ddlinn@manchester.edu.
authors.forename: Dustin D
authors.initials: DD
authors.lastname: Linn
authors.affiliation: Manchester University College of Pharmacy, Fort Wayne, IN, USA.
authors.forename: Kathryn C
authors.initials: KC
authors.lastname: Loeser
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy; D020927:Dexmedetomidine / Q000627:therapeutic use*; D000431:Ethanol / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units; D012121:Respiration, Artificial; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D013610:Tachycardia / Q000517:prevention & control
chemical_list: D006993:Hypnotics and Sedatives; D000431:Ethanol; D020927:Dexmedetomidine
keywords: alcohol intoxication; central nervous system; critical care; sedatives; substance abuse; sympatholytics; withdrawal