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To the Editor: Dr Riker and colleagues¹ compared midazolam vs dexmedetomidine for sedation in ICU patients. In Figure 1, of the initial 420 patients who provided consent, 1 patient was excluded for "drug dependence." However, since the initial study protocol did not state that patients with drug dependence were to be excluded, it was unclear why this occurred.

Dexmedetomidine is an imidazole compound that displays specific and selective ₂-adrenoreceptor affinity and has about 8 times greater affinity for the receptor than clonidine.² Clonidine has been used as a second-line agent for the treatment of alcohol withdrawal.³ Dexmedetomidine has multiple characteristics that indicate potential for the treatment of alcohol withdrawal. These include reducing heart rate, lowering systemic blood pressure, and providing sedation. Case reports show positive outcomes for dexmedetomidine use in alcohol-withdrawal patients.⁴ In addition, rodent studies show dexmedetomidine to alleviate symptoms in ethanol-dependent rats.⁵ Dexmedetomidine may also be helpful in . . . [Full Text of this Article]

Amit Gupta, MD
agupta1@hotmail.com

David Lee, MD; Mark Su, MD
Department of Emergency Medicine
North Shore University Hospital
Manhasset, New York

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RELATED ARTICLE

Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients: A Randomized Trial
Richard R. Riker, Yahya Shehabi, Paula M. Bokesch, Daniel Ceraso, Wayne Wisemandle, Firas Koura, Patrick Whitten, Benjamin D. Margolis, Daniel W. Byrne, E. Wesley Ely, Marcelo G. Rocha, and for the SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group
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Comparing Dexmedetomidine With Midazolam for Sedation of Patients in the ICU—Reply
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JAMA. 2009;301(23):2441-2442.
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