Dexmedetomidine

General

• Type: Alpha-2 agonists; Sedative agents
• Dosage Forms:IV
• Common Trade Names: Precedex (US), Dexdor (European)

Adult Dosing

ICU Sedation

• 1 mcg/kg over 10 minutes
  • Followed by 0.2 to 0.7 mcg/kg/hr

Procedural Sedation

• 1 mcg/kg over 10 minutes
  • Followed by 0.6 mcg/hr titrated to effect (generally 0.2 to 1 mcg/kg/hr)

Pediatric Dosing

Post-Intubation Sedation

• Do not bolus
• Start at 0.2-0.4 mcg/kg/hour and titrate to a max of 1.4 mcg/kg/hour
  • Recommended to start at 0.4 mcg/kg/hour for agitated patients
• Make changes every 15-20 minutes if not desired affect or sooner if patient is agitated
• May use with spot does of other medications like fentanyl and versed.
  • If on fentanyl or versed drip already should be able to titrate the dose down.

Special Populations

• Pregnancy Rating: C
• Lactation: Unknown if excreted in milk. Exercise caution
• Renal Dosing
  • Adult
  • Pediatric
• Hepatic Dosing
  • Adult
  • Pediatric

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Hypotension
• Bradycardia
• Apnea

Common

• Hypotension
• Bradycardia
• Dry mouth

Pharmacology

• Half-life: 2 hours
• Metabolism: Hepatic
• Excretion: Renal
• Mechanism of Action: Selective α-2 agonist

Comments

• Provides analgesia and anesthesia
• Hemodynamically neutral medication
• Provides sedation with maintenance of arousability, airway protection
• Preserves sleep architecture and decreases incidence of ICU delirium

See Also

• Sedation (Main)

References

• Precedex Drug Information