Home use of intranasal dexmedetomidine in a child with an intractable sleep disorder

Lucia De Zen, Irene Del Rizzo, Margherita Robazza, Francesca Barbieri, Marta Campagna, Silvia Vaccher, Egidio Barbi, Roberto Dall’amico

Research output: Contribution to journalArticlepeer-review

Abstract

Sleep disturbance is a crucial issue in pediatric palliative care, with a dramatic impact on the quality of life of children and families. Dexmedetomidine (DEX) is a selective α-2 agonist, with anxiolytic, hypnotic, and analgesic properties, that could play a role in the management of refractory sleep disturbances. We describe the use of intranasal DEX as a sleep inductor in a 10-year-old female with dystrophic epidermolysis bullosa and a severe sleep disorder. After treatment with melatonin, benzodiazepines, and niaprazine had failed, she was admitted to the hospital where 3 mcg/kg/day of intranasal DEX was administered before bedtime. She received 0.7 mL of the IV formulation at a concentration of 100 mcg/mL with half the dose given in each nostril via a Mucosal Atomization Device. During this time, she was also monitored for potential side effects (e.g., bradycardia, blood pressure derangements). After 2 weeks of hospitalization, she was discharged with ready-to-use doses of DEX for home treatment. The child’s heart rate and blood oxygen saturation were monitored at home. There was a definite improvement in sleep quality and duration, daytime alertness, pain control, and quality of life. No side effects were reported and the drug retained its effect over time (the patient is currently taking the drug). Intranasal DEX could be a safe and effective strategy to manage refractory sleep disturbances in children in pediatric palliative care.

Original languageEnglish
Pages (from-to)332-335
Number of pages4
JournalJournal of Pediatric Pharmacology and Therapeutics
Volume25
Issue number4
DOIs
Publication statusPublished - 2020

Keywords

  • Circadian rhythm
  • Dexmedetomidine
  • Intranasal dexmedetomidine
  • Pediatric palliative care
  • Sleep disturbance

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pharmacology (medical)

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