Trends in Supportive Medication Use Before, During, and After Dexmedetomidine Initiation in End-of-Life Palliative Care: A Descriptive Follow-up Study

Dexmedetomidine's benefits include opioid sparing, low respiratory impact and potential to maintain lucidity in those nearing end-of-life (EoL). This study aims to characterize the impact of dexmedetomidine infusion on EoL supportive psychotropic and pain medications. Investigators conducted a retrospective chart review of patients approaching EoL receiving dexmedetomidine infusion between January 2020 and December 2023. The primary outcome was concomitant medication dosing over the course of the dexmedetomidine infusion. Of the 25 patients, the majority were White (64%), male (56%) with solid tumor malignancy (80%) and a median age of 63 years. Five received concomitant pain medications (lidocaine: 4, ketamine: 1); two remained on lidocaine until death. Intravenous chlorpromazine doses remained stable nearing EoL (median: 75 mg/day). Patients on non-chlorpromazine antipsychotics had a longer dexmedetomidine duration (median: 18 vs. 5 days). Gabapentin was associated with the highest median dexmedetomidine dose (1.5 mcg/kg/hr) and a higher initial and terminal dexmedetomidine dose (0.4 and 1 mcg/kg/hr) when compared to valproic acid (0.2 and 0.75 mcg/kg/hr). Trends seen in this descriptive study suggest dexmedetomidine may serve as an important tool for adjunctive pain and symptom management, leading to meaningful distress reduction for patients.