Taming the tremors: Dexmedetomidine as a sober ally in alcohol withdrawal state: A case series

ABSTRACT Alcohol withdrawal syndrome (AWS) represents one of the most challenging complications in patients with chronic alcohol use disorder, particularly in severe forms such as delirium tremens or benzodiazepine-refractory withdrawal. Although benzodiazepines remain the standard of care, a subset of patients fail to achieve adequate symptom control despite escalating doses, thereby necessitating the use of adjunctive agents. Dexmedetomidine, a selective α2-adrenergic agonist, has emerged as a promising adjunctive drug in this setting due to its anxiolytic, sedative, and sympatholytic properties, while preserving respiratory drive. We describe five patients with severe AWS requiring intensive care unit admission. Dexmedetomidine infusion was administered in addition to benzodiazepines, and other supportive measures. Clinical response was assessed using the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar), Richmond Agitation-Sedation Scale (RASS), heart rate, blood pressure, benzodiazepine requirement, and adverse effects. Following initiation of dexmedetomidine, all five patients showed improved control of agitation and stabilization of autonomic hyperactivity. Benzodiazepine requirements decreased during treatment, and none of the patients required endotracheal intubation. Two patients developed transient bradycardia, which resolved after temporary dose reduction or interruption of the infusion. No serious cardiovascular or respiratory adverse event was observed. Dexmedetomidine may be a useful adjunct to benzodiazepines in carefully selected patients with inadequately controlled AWS, particularly when autonomic hyperactivity and agitation persist. Larger controlled studies are required to define optimal dosing, safety, and effects on clinically important outcomes.