DEXMEDETOMIDINE HYDROCHLORIDE
| DEXMEDETOMIDINE HYDROCHLORIDE (dex-med-e-to'mi-deen) Precedex Classifications: alpha2-adrenergic agonist; sedative-hypnotic; Therapeutic: sedative-hypnotic Prototype: Methoxamine HCl Pregnancy Category: C |
Availability
100 mcg/mL injection
Action
Dexmedetomidine stimulates alpha2-adrenergic receptors in the CNS (primarily in the medulla oblongata) causing inhibition of the sympathetic vasomotor center of the brain. Hemodynamic responses of the heart affected by alpha2 receptors are better controlled with dexmedetomidine than with other related drugs (e.g., midazolam).
Therapeutic Effect
Sedative properties utilized in intubating patients and for initially maintaining them on a mechanical ventilator.
Uses
Sedation of initially intubated or mechanically ventilated patients.
Contraindications
Hypersensitivity to dexmedetomidine; labor and delivery, including cesarean section, pregnancy (category C).
Cautious Use
Patients with arrhythmias or cardiovascular disease, uncontrolled hypertension; hypotension; cerebrovascular disease; renal or hepatic insufficiency; signs of light anesthesia; lactation; older adults >65 y. Safety and efficacy in children <18 y are unknown.
Route & Dosage
| Sedation Adult: IV 1 mcg/kg loading dose infused over 10 min, then continue with infusion of 0.2–0.7 mcg/kg/h for up to 24 h adjusted to maintain sedation Hepatic Impairment Reduce initial dosage. Renal Impairment Clcr <30 mL/min: reduce initial dose |
Administration
| Intravenous PREPARE: Continuous: Withdraw 2 mL of dexmedetomidine and add to 48 mL of 0.9% NaCl injection. Shake gently to mix. ADMINISTER: Continuous: Administer using a controlled infusion device. A loading dose of 1 mcg/kg is infused over 10 min followed by the ordered maintenance dose. Do NOT use administration set containing natural rubber. Do NOT infuse longer than 24 h. INCOMPATIBILITIES Y-site: Amphotericin B, diazepam. |
- Store at 15°–30° C (59°–86° F).
Adverse Effects (≥1%)
Body as a Whole: Pain, infection. CV: Hypotension, bradycardia, atrial fibrillation. GI: Nausea, thirst. Respiratory: Hypoxia, pleural effusion, pulmonary edema. Hematologic: Anemia, leukocytosis. Urogenital: Oliguria.Interactions
Drug: barbiturates, benzodiazepines, general anesthetics, opiate agonists, anxiolytics, sedatives/hypnotics, ethanol, tricyclic antidepressants, tramadol, phenothiazines, skeletal muscle relaxants, azatadine, brompheniramine, carbinoxamine, chlorpheniramine, clemastine, cyproheptadine, dexchlorpheniramine, dimenhydrinate, diphenhydramine, doxylamine, hydroxyzine, methdilazine, phenindamine, promethazine, tripelennamine enhance CNS depression possibly prolong recovery from anesthesia.Pharmacokinetics
Metabolism: Extensively in liver (CYP2A6). Elimination: Primarily in urine. Half-Life: 2 h.Nursing Implications
Assessment & Drug Effects
- Monitor for hypertension during loading dose; reduction of loading dose may be required.
- Monitor cardiovascular status continuously; notify physician immediately if hypotension or bradycardia occur.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug