PSHP 2026 Residency Conference

Purpose: This study aims to retrospectively analyze and evaluate the efficacy and safety of dexmedetomidine being tapered with and without clonidine in critically ill patients. A cost analysis comparing tapering methods was also conducted. 


Methods: This study includes patients aged 18 years and older who were admitted to the ICU from July 1, 2023, to June 30, 2025, and received dexmedetomidine intravenously for two or more consecutive days. Exclusion criteria include clonidine use solely for blood pressure management or for opioid withdrawal, and dexmedetomidine discontinuation within 48 hours of discharge. The primary endpoint includes the incidence of at least two signs of agitation or withdrawal from the start of infusion taper to 48 hours after dexmedetomidine discontinuation. Signs of withdrawal include a RASS score greater than +1, use of fast-acting sedatives, use of restraints, heart rate greater than 100 bpm, and systolic blood pressure greater than 140 mmHg or mean arterial pressure greater than 90 mmHg. Secondary endpoints include length of inpatient stay, length of ICU stay, duration of dexmedetomidine, and incidence of hypotension or bradycardia. 


Results: There was not a statistically significant difference in occurrence of at least three withdrawal symptoms between patients tapering dexmedetomidine with clonidine compared to tapering without clonidine (86.0% vs 83.7%; p=1.00). There was a greater incidence of RASS > +1 in the clonidine taper group (p=0.03). The clonidine taper group had a longer average inpatient length of stay (35 vs 24 days), average ICU length of stay (18 vs 16 days), and average duration of dexmedetomidine infusion (11 vs 7 days) compared to the group tapering without clonidine. The group tapering without clonidine had a higher incidence of hypotension and bradycardia. The overall cost was greater in the group tapering with clonidine ($18,410.96 vs $8,035.20). 


Conclusion: Prescribing bias led to the use of clonidine in more severe patients or with alcohol withdrawal, causing the group tapering with clonidine to have longer duration of stays and length of infusions. Overall, tapering dexmedetomidine with clonidine did not reduce the incidence of withdrawal compared to tapering dexmedetomidine without clonidine and tapering with clonidine did not provide a cost benefit.