Background: Dexmedetomidine (DEX) is an alpha-2 adrenergic drug used for short sedation and as an alternative to diazepam (DZP) in the treatment of alcohol withdrawal syndrome (AWS). Purpose: This study aims to compare the hemodynamic effect of DZP versus DEX on heart rate (HR) and blood pressure in patients with AWS. Methods: Prospective randomized clinical trial that includes 40 patients with AWS from Mérida, Yucatán, México. Results: Forty patients were randomly divided into two groups: one group DZP (n = 20) patients received diazepam (doses 5–20 mg IV) and the other group (n = 20) received DEX (dexmedetomidine infusion .2–.7 mcg/kg/min). We obtained statistical significance in sedation with the DEX group in the degree of traumatic brain injury I/II (p = .003). The DEX group remained haemodynamically stable in the first 24 h, the mean HR (73.85 ± 8.39) was significant comparing both groups (p = .002). In the comparison of the figures for the DEX group with the DZP (143.85 ± 2.30–137.95 ± 5.62) the SBP was significant with a (p = .0001). Furthermore, DEX treatment was shorter. Conclusion: Although DEX is not indicated for the routine treatment of AWS, this study proposes a positive effect on HR, SBP and fewer days of treatment compared to the standard DZP treatment for AWS. Clinical Trials.gov ID: NCT03877120—https://clinicaltrials.gov/ct2/show/NCT03877120.