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 [1]
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Ethanol withdrawal | 0.2-0.7 mcg/kg/hr IV drip | Adjunct alpha-2 agonist (supplemental to 1st line) | IV drip | Adult |
| Procedural sedation | 1 mcg/kg loading then 0.2-1 mcg/kg/hr | Procedural sedation | IV | Adult |
See Also
References
- ↑ Skrobik, Y., Duprey, M., Hill, N. and Devlin, J., 2018. Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial. American Journal of Respiratory and Critical Care Medicine, 197(9), pp.1147-1156.