I was sitting in my office finishing my medical records (which is painful enough) when I realized that I could barely move my arms. It felt like I had been lifting weights. But then I remember that I had not been lifting weights but I had been trying to restrain a patient (along with four nurses) who was going throught bad alcohol withdrawal.
It is always the same scenario. For some reason the patient with alcoholism loses access to the beverage of choice and day or two later goes into the withdrawal. In severe cases it could be life-threatening. Some patients could even have seizures.

I am always amazed how strong the patients with Delirium Tremens (DT) could get. We often end calling security just to pin the patient down. The patient from this morning was, actually, a female weighing no more that 70 kilograms, yet it took five of us to contain her.

Sedating patients going through DTs could be challenging as well. I ended up asking for multiple doses of intravenous Ativan and, yet, after giving 16mg with no effect on the patient’s agitation, I “gave up” and ordered the Precedex drip.

It worked like a charm.

Precedex is a newer sedative medication, primarily used in anesthesiology for cardiac surgery patients. The mechanism of action is via centrally (in the brain) located alpha receptors. This is similar to how Clonidine (blood pressure medicine) works, which makes it even more suitable for alcohol withdrawal.

Even, though, expensive and approved only for a short term use (24 hours), there is a study showing that Precedex could be used safely for longer periods of time. The same study also showed that using Precedex vs. Versed for sedation could be cost-effective.

The most common side effect of Precedex is mild hypotension. This too makes it a good candidate for patients with DTs since most of them are hypertensive.

More studies are needed to expand the spectrum of indications for this medication, yet, I bet you we are going to see it more and more in the ICU practice.