---
title: "Management of Medetomidine Withdrawal During Interfacility Transport: Outcomes of Patients on Dexm"
id: "pubmed-42748282"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42748282"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42748282/"
doi: "10.1080/10903127.2026.2728131"
published_at: "2026-09-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Management of Medetomidine Withdrawal During Interfacility Transport: Outcomes of Patients on Dexm
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42748282
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42748282/)
- **DOI:** [10.1080/10903127.2026.2728131](https://doi.org/10.1080%2F10903127.2026.2728131)
- **Published At:** 2026-09-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Alpha-2 agonists such as **medetomidine** are increasingly found as adulterants in the US opioid supply and can produce a withdrawal syndrome with severe symptoms including agitation and nausea. - Severe withdrawal from these agents is often treated with high-dose **dexmedetomidine** infusion and can require transfer from community EDs to tertiary critical care units. - This study was a retrospective observational cohort of consecutive non-intubated patients transported while receiving dexmedetomidine for suspected medetomidine withdrawal between March 2024 and February 2026. - The cohort included 100 patients; common pre- or on-arrival symptoms were agitation (53%), nausea/vomiting (58%), tachycardia or bradycardia (62%), and hypertension (71%). - During transport, medication adjustments were uncommon: 10% had dexmedetomidine titration, 12% received additional antiemetics, 9% received sedatives, and 1% received a vasoactive infusion for hypotension. - No patients required additional sedative infusions beyond dexmedetomidine, and no patients required advanced airway interventions during transport. - Many patients exhibited hypertension during transport: 78% had systolic blood pressure (SBP) >140 mmHg and 39% had profound hypertension (SBP >180 mmHg or diastolic BP >110 mmHg). - Tachycardia (HR >120) occurred in 35%, bradycardia (HR <50) in 6%, and hypotension (SBP <90 mmHg) in 6%. Hypoxia (SpO2 <90%) was present in 3%; similarly, 3% were treated with supplemental oxygen. - The study concludes that continued pharmacologic **alpha-2 agonism** with dexmedetomidine during transport is generally safe, with rare need for vasopressors or advanced airway management; early recognition and treatment are emphasized. - Details such as specific dosing regimens, patient comorbidities, and longer-term outcomes were not reported in the source abstract.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Management of Patients with Medetomidine Withdrawal During Interfacility Transfer [Justin K Kenney](https://pubmed.ncbi.nlm.nih.gov/?term=Kenney+JK&cauthor_id=42748282)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748282/#full-view-affiliation-1 "Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."), [Michael J Lynch](https://pubmed.ncbi.nlm.nih.gov/?term=Lynch+MJ&cauthor_id=42748282)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748282/#full-view-affiliation-1 "Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."), [Anthony F Pizon](https://pubmed.ncbi.nlm.nih.gov/?term=Pizon+AF&cauthor_id=42748282)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748282/#full-view-affiliation-1 "Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."), [Christian Martin-Gill](https://pubmed.ncbi.nlm.nih.gov/?term=Martin-Gill+C&cauthor_id=42748282)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748282/#full-view-affiliation-1 "Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.") Affiliations Expand ### Affiliation * 1 Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. * PMID: **42748282** * DOI: [ 10.1080/10903127.2026.2728131 ](https://doi.org/10.1080/10903127.2026.2728131) Item in Clipboard # Management of Patients with Medetomidine Withdrawal During Interfacility Transfer Justin K Kenney et al. Prehosp Emerg Care. 2026. Show details Display options Display options Format Abstract PubMed PMID Prehosp Emerg Care Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Prehosp+Emerg+Care%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Prehosp+Emerg+Care%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42748282/) . 2026 Sep 16:1-6. doi: 10.1080/10903127.2026.2728131. Online ahead of print. ### Authors [Justin K Kenney](https://pubmed.ncbi.nlm.nih.gov/?term=Kenney+JK&cauthor_id=42748282)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748282/#short-view-affiliation-1 "Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."), [Michael J Lynch](https://pubmed.ncbi.nlm.nih.gov/?term=Lynch+MJ&cauthor_id=42748282)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748282/#short-view-affiliation-1 "Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."), [Anthony F Pizon](https://pubmed.ncbi.nlm.nih.gov/?term=Pizon+AF&cauthor_id=42748282)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748282/#short-view-affiliation-1 "Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."), [Christian Martin-Gill](https://pubmed.ncbi.nlm.nih.gov/?term=Martin-Gill+C&cauthor_id=42748282)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42748282/#short-view-affiliation-1 "Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.") ### Affiliation * 1 Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. * PMID: **42748282** * DOI: [ 10.1080/10903127.2026.2728131 ](https://doi.org/10.1080/10903127.2026.2728131) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objectives:** Alpha-2 agonists including medetomidine are becoming increasingly prevalent as adulterants in the United States opioid supply. Complicated withdrawal following use of these agents is characterized by severe symptoms including agitation and nausea, often requiring treatment with high-dose dexmedetomidine infusion and transfer between community emergency departments and tertiary critical care units. We aimed to describe interventions and outcomes of patients undergoing interfacility transport while receiving a dexmedetomidine infusion for medetomidine withdrawal to inform safe transfer practices for this patient population. **Methods:** We performed a retrospective observational cohort study of consecutive non-intubated patients receiving dexmedetomidine infusion for management of suspected medetomidine withdrawal transported by a regional critical care transport agency between March 2024 and February 2026. We identified clinical characteristics, characterized withdrawal symptoms, and identified the incidence of and indications for supplemental medical therapy provided during transport. We also identified the prevalence of hemodynamic instability, hypoxia, or need for advanced airway interventions. **Results:** Among the 100 patients receiving dexmedetomidine infusion for suspected medetomidine withdrawal, most experienced agitation (53%), nausea/vomiting (58%), tachycardia/bradycardia (62%), or hypertension (71%) upon or prior to crew arrival. During transport, 10% of patients received dexmedetomidine titration, 12% received additional antiemetics, 9% received sedatives, and 1% received vasoactive infusion for hypotension. No patients received additional sedative infusions. Many patients exhibited hypertension (systolic blood pressure [SBP] > 140 mmHg; 78%) or profound hypertension (SBP >180 mmHg or diastolic BP >110 mmHg; 39%). Patients also experienced tachycardia (heart rate [HR] > 120; 35%), bradycardia (HR <50; 6%), or hypotension (SBP <90 mmHg; 6%). Only 3% of patients experienced hypoxia (SpO2 < 90%), or were treated with supplemental oxygen, and no patients required advanced airway management. **Conclusions:** Patients undergoing transport while receiving dexmedetomidine infusion for suspected medetomidine withdrawal were commonly hypertensive and rarely hypoxic. While some patients required additional antiemetic or sedative medications, no patients required alternate sedative infusions, most remained stable on the dexmedetomidine infusion, and need for vasopressors was very rare. Early symptom recognition and pharmacologic alpha-2 agonism are likely key in prehospital management of this toxidrome, which can safely be continued during interfacility transport. 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