Dexmedetomidine with transition to oral clonidine for stabilization of refractory agitation: A case report.
Kelvin Lou, Brian Chun-Mond Li, Shikha Minhas et al.
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Case in brief
A 45-year-old man with metastatic medullary thyroid carcinoma was admitted to a palliative care unit with severe opioid-refractory pain, delirium, and agitation that prevented palliative radiation. A dexmedetomidine infusion, titrated to 0.6 µg/kg/hr, controlled symptoms while preserving wakefulness, allowing diagnostic reassessment and completion of radiation. Over 1 week, dexmedetomidine was tapered as oral clonidine was increased from 0.1 mg three times a day to 0.5 mg four times a day. He had no recurrent agitation or hemodynamic instability, was discharged home, and remained clinically stable 5 months later.
What made this case unusual
Dexmedetomidine was used as a stabilizing bridge—not terminal sedation—and cross-tapered to oral clonidine to support discharge home in a patient with advanced cancer and a longer prognosis.
Diagnostic / clinical pearl
In this case, dexmedetomidine controlled refractory agitation while preserving wakefulness; a gradual transition to oral clonidine enabled discontinuation of intravenous therapy without symptom recurrence or hemodynamic instability.
Why it matters
The report highlights a potential route from inpatient symptom stabilization to outpatient management, while noting that prospective studies are needed to establish transition protocols and identify suitable candidates.