{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:19:25Z","timestamp":1784697565897,"version":"3.55.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Sublingual dexmedetomidine is a recently introduced \u03b12-adrenergic agonist approved for management of agitation in patients with schizophrenia or bipolar disorder. Published safety data on the use of this drug outside of clinical trials is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>We describe an 88-year-old patient with hypertension, vascular dementia, and non\u2013ST segment elevation myocardial infarction who experienced profound hypotension after receiving sublingual dexmedetomidine for agitation. The patient was boarding in the emergency department due to hospital overcrowding and developed delirium with severe agitation. After QT interval prolongation limited further antipsychotic use, a 120-\u00b5g dose of sublingual dexmedetomidine was administered. Within 1\u2005hour, the patient\u2019s blood pressure fell from 102\/49 to 62\/40\u2005mm Hg. Concomitantly, her hemoglobin declined from 12.1 to 6.9\u2005g\/dL, prompting a blood transfusion and investigation of active bleeding. Imaging revealed a large intramuscular hematoma possibly related to intramuscular injections in the setting of therapeutic anticoagulation and dual antiplatelet therapy. The Naranjo score was 4, indicating a possible adverse drug reaction to dexmedetomidine; however, the strong temporal association with sublingual administration supports a contributory role.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the hemodynamic vulnerability of older adults, especially those with comorbidities and recent anticoagulation. While sublingual dexmedetomidine offers a noninvasive option for agitation management, its hypotensive potential may be clinically significant in this population. Our findings underscore the need for careful patient selection, dose optimization, and close monitoring when using dexmedetomidine in elderly patients, especially those with limited cardiovascular reserve. Further research is needed to guide safe dosing in geriatric and medically complex populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajhp\/zxaf335","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T13:38:22Z","timestamp":1764941902000},"page":"e384-e389","source":"Crossref","is-referenced-by-count":2,"title":["Severe hypotension following sublingual dexmedetomidine administration in an elderly patient"],"prefix":"10.1093","volume":"83","author":[{"given":"Zlatan","family":"Coralic","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy and Emergency Medicine, University of California San Francisco , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moujan","family":"Allai","sequence":"additional","affiliation":[{"name":"University of California San Francisco School of Pharmacy , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University of California San Francisco , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Michaels","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University of California San Francisco , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Takamoto","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University of California San Francisco , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"2026052601022327300_zxaf335-B1","author":"Precedex (dexmedetomidine hydrochloride) injection"},{"key":"2026052601022327300_zxaf335-B2","author":"Igalmi (dexmedetomidine) sublingual film"},{"issue":"2","key":"2026052601022327300_zxaf335-B3","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/clpt.1981.154","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","journal-title":"Clin Pharmacol Ther"},{"issue":"6","key":"2026052601022327300_zxaf335-B4","doi-asserted-by":"crossref","first-page":"22m14447","DOI":"10.4088\/JCP.22m14447","article-title":"Sublingual dexmedetomidine for the treatment of acute agitation in adults with schizophrenia or schizoaffective disorder: a randomized placebo-controlled trial","volume":"83","author":"Citrome","year":"2022","journal-title":"J Clin Psychiatry"},{"issue":"8","key":"2026052601022327300_zxaf335-B5","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1001\/jama.2022.0799","article-title":"Effect of sublingual dexmedetomidine vs placebo on acute agitation associated with bipolar disorder: a randomized clinical trial","volume":"327","author":"Preskorn","year":"2022","journal-title":"JAMA"},{"key":"2026052601022327300_zxaf335-B6","author":"BioXcel Therapeutics, Inc"},{"issue":"7","key":"2026052601022327300_zxaf335-B7","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1080\/14740338.2017.1323867","article-title":"Empirical estimation of under-reporting in the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS)","volume":"16","author":"Alatawi","year":"2017","journal-title":"Exp Opin Drug Saf"},{"issue":"13","key":"2026052601022327300_zxaf335-B8","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1212\/WNL.0b013e318230201a","article-title":"Short-acting nifedipine and risk of stroke in elderly hypertensive patients","volume":"77","author":"Jung","year":"2011","journal-title":"Neurology"},{"key":"2026052601022327300_zxaf335-B9"},{"issue":"1","key":"2026052601022327300_zxaf335-B10","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1186\/s12871-022-01811-5","article-title":"Effects of dexmedetomidine on cardiac electrophysiology in patients undergoing general anesthesia during perioperative period: a randomized controlled trial","volume":"22","author":"Tan","year":"2022","journal-title":"BMC Anesthesiol"},{"issue":"2","key":"2026052601022327300_zxaf335-B11","doi-asserted-by":"crossref","first-page":"517","DOI":"10.3349\/ymj.2014.55.2.517","article-title":"Effect of dexmedetomidine on the corrected QT and Tp-e intervals during spinal anesthesia","volume":"55","author":"Kim","year":"2014","journal-title":"Yonsei Med J"},{"issue":"19","key":"2026052601022327300_zxaf335-B12","doi-asserted-by":"crossref","first-page":"e3645","DOI":"10.1097\/MD.0000000000003645","article-title":"Effect of dexmedetomidine on heart rate-corrected QT and Tpeak-Tend intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg position: a prospective, randomized, double-blinded, controlled study","volume":"95","author":"Kim","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"4","key":"2026052601022327300_zxaf335-B13","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1213\/ANE.0000000000004135","article-title":"Effects of dexmedetomidine on myocardial repolarization in children undergoing general anesthesia: a randomized controlled trial","volume":"129","author":"Gorges","year":"2019","journal-title":"Anesth Analg"},{"issue":"1184","key":"2026052601022327300_zxaf335-B14","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1093\/postmj\/qgae006","article-title":"Price for waiting: the adverse outcomes of boarding critically ill elderly medical patients in the emergency department","volume":"100","author":"Huang","year":"2024","journal-title":"Postgrad Med J"},{"issue":"6","key":"2026052601022327300_zxaf335-B15","doi-asserted-by":"crossref","first-page":"e2416343","DOI":"10.1001\/jamanetworkopen.2024.16343","article-title":"Boarding duration in the emergency department and inpatient delirium and severe agitation","volume":"7","author":"Joseph","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"3","key":"2026052601022327300_zxaf335-B16","doi-asserted-by":"crossref","first-page":"532","DOI":"10.5811\/WESTJEM.59383","article-title":"Emergency department length of stay is associated with delirium in older adults","volume":"24","author":"Elder","year":"2023","journal-title":"West J Emerg Med"},{"issue":"4","key":"2026052601022327300_zxaf335-B17","doi-asserted-by":"crossref","first-page":"594","DOI":"10.3390\/neurolint13040059","article-title":"Benzodiazepines: uses, dangers, and clinical considerations","volume":"13","author":"Edinoff","year":"2021","journal-title":"Neurol Int"},{"key":"2026052601022327300_zxaf335-B18","doi-asserted-by":"crossref","first-page":"e076268","DOI":"10.1136\/bmj-2023-076268","article-title":"Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study","volume":"385","author":"Mok","year":"2024","journal-title":"BMJ"},{"issue":"6","key":"2026052601022327300_zxaf335-B19","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1053\/j.jvca.2014.03.010","article-title":"Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically Ill patients: a meta-analysis of randomized controlled trials","volume":"28","author":"Pasin","year":"2014","journal-title":"J Cardiothorac Vasc Anesth"}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxaf335\/65788952\/zxaf335.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/83\/11\/e384\/65788952\/zxaf335.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/83\/11\/e384\/65788952\/zxaf335.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T05:02:29Z","timestamp":1779771749000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/83\/11\/e384\/8373348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,6]]},"references-count":19,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,12,6]]},"published-print":{"date-parts":[[2026,5,26]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxaf335","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6,1]]},"published":{"date-parts":[[2025,12,6]]}}}