If you are treating an alcohol withdrawal patient and benzodiazepines are not working, try dexmedetomidine (precedex). This centrally acting alpha-2 agonist was utilized in 18 ICU patients and was shown to be safe. Average diazepam dose was 193 mg IV and lorazepam dose was 9 mg IV in these patients. Haloperidol was utilized in 3 of these patients which is not an effective therapy for alcohol withdrawal (could worsen due to QT prolongation, decrease seizure threshold and anticholinergic effects).
Still requires further research and not sure about the physiologic mechanism dexmedetomidine would actually treat alcohol withdrawal aside from sedating. There is the added benefit of maintaining airway reflexes versus propofol. This case series shows the experience with this drug regimen.
1. Tolonen J et al. Dexmedetomidine in addition to benzodiazepine-based
sedation in patients with alcohol withdrawal delirium. Eur J Emerg
