Off-label dexmedetomidine use in palliative patients

Hospice patients experience a variety of symptoms in the last hours and days of life, which cause mental and physical suffering. One form of management is the use of controlled sedation. It aims to relieve symptoms that are resistant to treatment and cannot be controlled by other methods. A new group of drugs that are helpful in reducing agitation and controlled sedation of the patient, and are applicable in shallow procedural sedation of patients in end-stage life-threatening diseases, are those acting on alpha-2-adrenergic receptors in the CNS: dexmedetomidine and clonidine. This review presents the actions and possible benefits of dexmedetomidine in palliative medicine, including the following: easier control of sedation compared to widely used benzodiazepines, clinically significant improvement in the treatment of pain with opioid drugs and reduction of the need for opioids, improvement of sleep quality, better control of shortness of breath, vomiting, and cough, and the neuroprotective effect of the drug. Dexmedetomidine exhibits clinical effects by various routes of administration – intravenous, subcutaneous, or intranasal – and it is also possible to use it in combination with other drugs widely used in palliative medicine. For situations in which all treatments are exhausted, palliative sedation is considered helpful and highly effective, and dexmedetomidine provides an interesting alternative to benzodiazepines.