dexmedetomidine (dex-me-de-to-mi-deen) Precedex

 Indications

Sedation of initially intubated and mechanically ventilated

patients during treatment in an intensive care setting;

should not be used for 24 hr. Sedation of non-intubated

patients before and/or during surgical and

other procedures.

Action

Acts as a relatively selective alpha-adrenergic agonist

with sedative properties. Therapeutic Effects: Sedation.

Pharmacokinetics

Absorption: IV administration results in complete

bioavailability.

Distribution: Unknown.

Protein Binding: 94%.

Metabolism and Excretion: Mostly metabolized

by the liver, some metabolism by P450 enzyme system.

Metabolites are mostly excreted in urine.

Half-life: 2 hr.

TIME/ACTION PROFILE (sedation)

ROUTE ONSET PEAK DURATION

IV rapid unknown unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity.

Use Cautiously in: Hepatic impairment (lower

doses may be required); Advanced heart block; Severe

left ventricular dysfunction; Geri:qrisk of bradycardia and hypotension (consider dosep); OB, Lactation,

Pedi: Safety not established.

Adverse Reactions/Side Effects

Resp: hypoxia. CV: BRADYCARDIA, SINUS ARREST, hypotension,

transient hypertension. GI: dry mouth, nausea,

vomiting. Hemat: anemia. Misc: fever.

Interactions

Drug-Drug: Sedation is enhanced by anesthetics,

other sedative/hypnotics, and opioid analgesics.

Drug-Natural Products: Concomitant use of

kava-kava, valerian, skullcap, chamomile, or

hops canqCNS depression.

Route/Dosage

ICU Sedation

IV (Adults): Loading infusion—1 mcg/kg over 10

min followed by maintenance infusion of 0.2–0.7

mcg/kg/hr for maximum of 24 hr; rate is adjusted to

achieve desired level of sedation.

IV (Children): Loading infusion—0.5–1 mcg/kg

followed by maintenance infusion of 0.2–1 mcg/kg/

hr. Children 1 yr may require higher end of infusion

rate.

Procedural Sedation

IV (Adults): Loading infusion—1 mcg/kg (0.5 mcg/

kg for ophthalmic surgery or patients 65 yr) over 10

min followed by maintenance infusion of 0.6 mcg/kg/

hr; rate is adjusted to achieve desired level of sedation

(usual range 0.2–1 mcg/kg/hr) (maintenance infusion

of 0.7 mcg/kg/hr recommended for fiberoptic intubation

until endotracheal tube secured).

Availability (generic available)

Solution for injection (requires further dilution):

100 mcg/mL. Premixed infusion (in 0.9%

NaCl): 4 mcg/mL.