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Effect of Sublingual Dexmedetomidine vs Placebo on Acute Agitation Associated with Bipolar Disorder Preskorn S, Zeller S, Citrome L, et al. JAMA. 2022;327(8):727-736. doi:10.1001/jama.2022.0799

        Acute agitation ranging from mild uneasiness to severe aggression or violence is commonly encountered by healthcare workers. The agitation can often be associated with neurological, psychiatric, and general medical conditions. Often less invasive, verbal and nonverbal de-escalation techniques are used, but frequently pharmacotherapy is needed, such as antipsychotics, benzodiazepines, and ketamine. Only intramuscular (IM) olanzapine and inhaled loxapine are indicated for treatment of agitation associated with bipolar disorder. Dexmedetomidine is an α2-adrenergic receptor agonist approved in intravenous form for procedural sedation and anesthesia. Dexmedetomidine has also been formulated into a rectangular sublingual film that can bypass first-pass metabolism and achieve higher bioavailability than ingested formulations. Sublingual dexmedetomidine has demonstrated dose-dependent exposure and plasma half-life between 2 and 3 hours.
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