Sublingual Dexmedetomidine as a Potential New Treatment for Agitation
Author Affiliations Article Information
JAMA. 2022;327(8):723-725. doi:10.1001/jama.2021.21313
An out-of-control, agitated, possibly aggressive patient in a medical setting is a crisis demanding swift and safe resolution. Traditionally, behavioral agitation, often due to psychosis, was managed by psychiatry, particularly when physical restraints were the primary options.1 After chlorpromazine’s calming, neuroleptic properties were recognized in the 1950s,2 pharmacological management became possible. Additional first-generation neuroleptic antipsychotics were introduced through the 1960s. In subsequent decades, the pharmaceutical industry developed the second-generation antipsychotics and benzodiazepines now used to treat agitation. ..
The study by Preskorn et al in this issue of JAMA both introduces and provides evidence to support a novel, potentially important addition to the armamentarium for managing behavioral agitation. Whether film sublingual dexmedetomidine receives regulatory approval and for which indications remains to be determined. Nevertheless, even if this form of sublingual dexmedetomidine is never marketed (or its cost is prohibitive), the results from this clinical trial call attention to novel-use cases for dexmedetomidine outside the critical care setting and beyond sedation for procedures. .
Joseph (Joe) E. Thornton, M.D., DFAPA
Gator Psychiatry 