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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