Dexmedetomidine as Adjunctive Therapy for Alcohol Withdrawal

The objectives of this randomized, double-blind, placebo controlled, dose escalation study are a) to determine if adding dexmedetomidine to symptom-triggered, standard therapy of severe alcohol withdrawal reduces the dose requirements of conventional sedatives, analgesics, and neuroleptics; maintains patient comfort and safety; and prevents and shortens tracheal intubation; b) to explore whether dexmedetomidine acts in a dose-dependent manner to reduce the dose requirements of conventional sedatives, analgesics, and neuroleptics while maintaining patient comfort; and c) determine the association between alcohol withdrawal and potential serum biomarkers of alcohol withdrawal and assess whether these are expressed differently when dexmedetomidine is used as adjunctive therapy. Dexmedetomidine will be added to existing sedative therapies in an effort to decrease the use of these agents while maintaining patient comfort. The study will randomize twenty-four patients in a double-blind manner to receive placebo or dexmedetomidine at doses of 0.4 or 1.2 µg/kg per hour for a maximum duration of five days. All patients will be managed using an existing institution-specific, symptom-triggered alcohol withdrawal protocol.

Inclusion criteria

• Severe alcohol withdrawal defined by a CIWA score ≥ 15 and the need for at least 16 mg of lorazepam over a four-hour period. All lorazepam doses, whether oral or intravenous, will contribute to the cumulative amount.
• Patients receiving standard therapy for severe alcohol withdrawal according to a symptom-triggered alcohol withdrawal protocol. Lorazepam is the preferred benzodiazepine agent for patients requiring ICU admission due to alcohol withdrawal.
• Informed consent within 36 hours of qualifying for the study.

Exclusion criteria

• Patients < 18 years of age or > 85 years of age.
• Patients receiving benzodiazepine therapy for purposes other than alcohol withdrawal (e.g. sedation).
• Patients with alcohol withdrawal not requiring ICU admission.
• Patients receiving epidural administration of medication(s).
• Comatose patients by metabolic or neurologic affectation.
• Patients with active myocardial ischemia or second- or third-degree heart block.
• Moribund state with planned withdrawal of life support.
• Patients with known or suspected severe adverse reactions to dexmedetomidine (or clonidine).
• Pregnant females or females suspected of being pregnant