Alpha2 Agonist Use in Critically Ill Adults: A Focus on Sedation and Withdrawal Prevention.

Autor: Schuler A; Department of Pharmacy, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA., Yoon CH; Department of Pharmacy, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA., Caffarini E; Department of Pharmacy, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA., Heine A; Department of Pharmacy, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA., Meester A; Department of Pharmacy, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA., Murray D; Department of Pharmacy, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA., Harding A; Department of Pharmacy, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA.
Jazyk: angličtina
Zdroj: Journal of pharmacy practice [J Pharm Pract] 2025 Feb; Vol. 38 (1), pp. 155-167. Date of Electronic Publication: 2024 Jun 21.
DOI: 10.1177/08971900241263171
Abstrakt: The management of sedation in critically ill adults poses a unique challenge to clinicians. Dexmedetomidine, an α 2 agonist, has a unique mechanism and favorable pharmacokinetics, making it an attractive intravenous option for sedation and delirium in the intensive care unit. However, patients may be at risk for withdrawal with prolonged use, adding to the complexity of sedation and agitation management in this patient population. Enteral α 2 agents have the benefit of cost savings and ease of administration, thus playing a role in the ability to decrease intravenous sedative use and prevent dexmedetomidine withdrawal. Clonidine and guanfacine are the two most common enteral α 2 agents utilized for this purpose, however, there is a paucity of evidence regarding the comparative benefit between the two agents. The decision to use one vs the other agent should be determined based on their differing pharmacology, pharmacokinetics, and side effect profile. The most effective dosing strategy for these agents is also unknown. Ultimately, more robust literature is required to determine enteral α 2 agonists place in therapy. This narrative review evaluates the currently available literature on the use of α 2 agonists in critically ill adults with an emphasis on sedation, delirium, and withdrawal.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze: MEDLINE
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