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    Drugs & Diseases

    dexmedetomidine (Rx)

    Brand and Other Names:Precedex
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    Dosing & Uses

    AdultPediatricGeriatric

    Dosage Forms & Strengths

    injectable solution

    • 200mcg/2mL (100mcg/mL) single-dose glass vial
    • Requires further dilution before administering

    ready-to-use injectable solution

    • 80mcg/20mL 0.9% NaCl (4mcg/mL)
    • 200mcg/50mL 0.9% NaCl (4mcg/mL)
    • 400mcg/100mL 0.9% NaCl (4mcg/mL)

    ICU Sedation

    Indicated for sedation of initially intubated and mechanically ventilated patients in ICU setting

    Load: 1 mcg/kg IV over 10 minutes; loading dose may not be required for adults converted from other sedative therapy  

    Maintenance 0.2-0.7 mcg/kg/hr continuous IV infusion; not to exceed 24 hr

    Dexmedetomidine has been continuously infused in mechanically ventilated patients before, during, and after extubation; it is not necessary to discontinue dexmedetomidine before extubation

    Procedural Sedation

    Indicated for sedation of nonintubated patients before and/or during surgical and other procedures

    Load: 1 mcg/kg IV over 10 minutes

    Maintenance 0.6 mcg/kg/hr IV titrate to effect (usually 0.2-1 mcg/kg/hr)  

    Awake fiberoptic Intubation

    • Load: 1 mcg/kg IV over 10 minutes  
    • Maintenance 0.7 mcg/kg/hr IV until endotracheal tube secured

    Dosage Modifications

    Dose reduction may be required if coadministered with other concomitant anesthetics, sedatives, hypnotics, or opioids

    Consider dose reduction in patients with hepatic impairment or aged ≥65 yr; clearance decreases with increasing severity of hepatic impairment

    Renal impairment: No dosage adjustment required

    Safety and efficacy not established

    ICU Sedation

    Indicated for sedation of initially intubated and mechanically ventilated patients in ICU setting; not to exceed 24 hr

    Consider dose reduction: Higher incidence of bradycardia and hypotension was observed following administration in patients aged >65 yr

    Dexmedetomidine has been continuously infused in mechanically ventilated patients before, during, and after extubation; it is not necessary to discontinue dexmedetomidine before extubation

    Procedural sedation

    Indicated for sedation of nonintubated patients before and/or during surgical and other procedures

    Reduced loading dose recommended: 0.5 mcg/kg IV over 10 minutes  

    Maintenance: Consider reduced maintenance infusion

    Next:

    Interactions

    Interaction Checker

    and dexmedetomidine

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              Contraindicated (1)

              • eliglustat

                dexmedetomidine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.

              Serious - Use Alternative (9)

              • calcium/magnesium/potassium/sodium oxybates

                dexmedetomidine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • hydrocodone

                hydrocodone, dexmedetomidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • lonafarnib

                dexmedetomidine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

              • metoclopramide intranasal

                dexmedetomidine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • ponesimod

                ponesimod, dexmedetomidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

              • sodium oxybate

                dexmedetomidine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • sufentanil SL

                sufentanil SL, dexmedetomidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • valerian

                valerian and dexmedetomidine both increase sedation. Avoid or Use Alternate Drug.

              • vortioxetine

                dexmedetomidine increases levels of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Decrease vortioxetine dose by 50% when coadministered with strong CYP2D6 inhibitors.

              Monitor Closely (195)

              • albuterol

                dexmedetomidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • alfentanil

                dexmedetomidine and alfentanil both increase sedation. Use Caution/Monitor.

              • alprazolam

                alprazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • amitriptyline

                dexmedetomidine and amitriptyline both increase sedation. Use Caution/Monitor.

              • amobarbital

                amobarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • amoxapine

                dexmedetomidine and amoxapine both increase sedation. Use Caution/Monitor.

              • apomorphine

                dexmedetomidine and apomorphine both increase sedation. Use Caution/Monitor.

              • arformoterol

                dexmedetomidine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • aripiprazole

                dexmedetomidine and aripiprazole both increase sedation. Use Caution/Monitor.

              • armodafinil

                dexmedetomidine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • avapritinib

                dexmedetomidine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • axitinib

                dexmedetomidine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • azelastine

                azelastine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • baclofen

                dexmedetomidine and baclofen both increase sedation. Use Caution/Monitor.

              • belladonna and opium

                dexmedetomidine and belladonna and opium both increase sedation. Use Caution/Monitor.

              • benazepril

                dexmedetomidine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

              • benperidol

                dexmedetomidine and benperidol both increase sedation. Use Caution/Monitor.

              • benzphetamine

                dexmedetomidine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • brexpiprazole

                dexmedetomidine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer half of the usual brexpiprazole dose when coadministered with strong CYP2D6 inhibitors. If also administered with a strong/moderate CYP3A4 inhibitor, administer a quarter of brexpiprazole dose. NOTE: In MDD clinical trials, brexpiprazole dosage was not adjusted for strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine); thus, CYP considerations are already factored into general dosing recommendations and brexpiprazole may be administered without dosage adjustment in patients with MDD.

              • brompheniramine

                brompheniramine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • buprenorphine

                dexmedetomidine and buprenorphine both increase sedation. Use Caution/Monitor.

              • buprenorphine buccal

                dexmedetomidine and buprenorphine buccal both increase sedation. Use Caution/Monitor.

              • buprenorphine, long-acting injection

                dexmedetomidine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

              • butabarbital

                butabarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • butalbital

                butalbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • butorphanol

                dexmedetomidine and butorphanol both increase sedation. Use Caution/Monitor.

              • caffeine

                dexmedetomidine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • captopril

                dexmedetomidine, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

              • carbinoxamine

                carbinoxamine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • carisoprodol

                dexmedetomidine and carisoprodol both increase sedation. Use Caution/Monitor.

              • cenobamate

                cenobamate, dexmedetomidine. Either increases effects of the other by sedation. Use Caution/Monitor.

              • chloral hydrate

                chloral hydrate and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • chlordiazepoxide

                chlordiazepoxide and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • chlorpheniramine

                chlorpheniramine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • chlorpromazine

                dexmedetomidine and chlorpromazine both increase sedation. Use Caution/Monitor.

              • chlorzoxazone

                dexmedetomidine and chlorzoxazone both increase sedation. Use Caution/Monitor.

              • cinnarizine

                cinnarizine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • clemastine

                clemastine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • clomipramine

                dexmedetomidine and clomipramine both increase sedation. Use Caution/Monitor.

              • clonazepam

                clonazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • clorazepate

                clorazepate and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • clozapine

                dexmedetomidine and clozapine both increase sedation. Use Caution/Monitor.

              • codeine

                dexmedetomidine and codeine both increase sedation. Use Caution/Monitor.

              • cyclizine

                cyclizine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • cyclobenzaprine

                dexmedetomidine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

              • cyproheptadine

                cyproheptadine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • dantrolene

                dexmedetomidine and dantrolene both increase sedation. Use Caution/Monitor.

              • desflurane

                desflurane and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • desipramine

                dexmedetomidine and desipramine both increase sedation. Use Caution/Monitor.

              • dexchlorpheniramine

                dexchlorpheniramine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • dexfenfluramine

                dexmedetomidine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexmethylphenidate

                dexmedetomidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dextroamphetamine

                dexmedetomidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dextromoramide

                dexmedetomidine and dextromoramide both increase sedation. Use Caution/Monitor.

              • diamorphine

                dexmedetomidine and diamorphine both increase sedation. Use Caution/Monitor.

              • diazepam

                diazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • diazepam intranasal

                diazepam intranasal, dexmedetomidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

              • dichlorphenamide

                dichlorphenamide and dexmedetomidine both decrease serum potassium. Use Caution/Monitor.

              • diethylpropion

                dexmedetomidine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • difenoxin hcl

                dexmedetomidine and difenoxin hcl both increase sedation. Use Caution/Monitor.

              • dimenhydrinate

                dimenhydrinate and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • diphenoxylate hcl

                dexmedetomidine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

              • dipipanone

                dexmedetomidine and dipipanone both increase sedation. Use Caution/Monitor.

              • dobutamine

                dexmedetomidine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dopamine

                dexmedetomidine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dopexamine

                dexmedetomidine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                dexmedetomidine and dosulepin both increase sedation. Use Caution/Monitor.

              • doxepin

                dexmedetomidine and doxepin both increase sedation. Use Caution/Monitor.

              • doxylamine

                dexmedetomidine and doxylamine both increase sedation. Use Caution/Monitor.

              • droperidol

                dexmedetomidine and droperidol both increase sedation. Use Caution/Monitor.

              • eluxadoline

                dexmedetomidine increases levels of eluxadoline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2D6 inhibitors.

              • ephedrine

                dexmedetomidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • epinephrine

                dexmedetomidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • epinephrine racemic

                dexmedetomidine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • estazolam

                estazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • ethanol

                dexmedetomidine and ethanol both increase sedation. Use Caution/Monitor.

              • etomidate

                etomidate and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • fenfluramine

                dexmedetomidine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • finerenone

                dexmedetomidine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

              • flibanserin

                dexmedetomidine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

                dexmedetomidine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

              • fluphenazine

                dexmedetomidine and fluphenazine both increase sedation. Use Caution/Monitor.

              • flurazepam

                flurazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • formoterol

                dexmedetomidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • gotu kola

                gotu kola increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

              • haloperidol

                dexmedetomidine and haloperidol both increase sedation. Use Caution/Monitor.

              • hawthorn

                hawthorn increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

              • hops

                hops increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

              • hydromorphone

                dexmedetomidine and hydromorphone both increase sedation. Use Caution/Monitor.

              • hydroxyzine

                hydroxyzine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • iloperidone

                dexmedetomidine and iloperidone both increase sedation. Use Caution/Monitor.

              • imipramine

                dexmedetomidine and imipramine both increase sedation. Use Caution/Monitor.

              • isoproterenol

                dexmedetomidine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ivacaftor

                dexmedetomidine increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

              • kava

                kava increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

              • ketamine

                ketamine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • ketotifen, ophthalmic

                dexmedetomidine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

              • lemborexant

                dexmedetomidine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

              • levalbuterol

                dexmedetomidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • levorphanol

                dexmedetomidine and levorphanol both increase sedation. Use Caution/Monitor.

              • lisdexamfetamine

                dexmedetomidine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lofepramine

                dexmedetomidine and lofepramine both increase sedation. Use Caution/Monitor.

              • lofexidine

                dexmedetomidine and lofexidine both increase sedation. Use Caution/Monitor.

              • lomitapide

                dexmedetomidine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

              • loprazolam

                loprazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • lorazepam

                lorazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • lormetazepam

                lormetazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • loxapine

                dexmedetomidine and loxapine both increase sedation. Use Caution/Monitor.

              • loxapine inhaled

                dexmedetomidine and loxapine inhaled both increase sedation. Use Caution/Monitor.

              • lurasidone

                lurasidone and dexmedetomidine both increase pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS effects

              • maprotiline

                dexmedetomidine and maprotiline both increase sedation. Use Caution/Monitor.

              • marijuana

                dexmedetomidine and marijuana both increase sedation. Use Caution/Monitor.

              • melatonin

                dexmedetomidine and melatonin both increase sedation. Use Caution/Monitor.

              • meperidine

                dexmedetomidine and meperidine both increase sedation. Use Caution/Monitor.

              • meprobamate

                dexmedetomidine and meprobamate both increase sedation. Use Caution/Monitor.

              • metaproterenol

                dexmedetomidine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • metaxalone

                dexmedetomidine and metaxalone both increase sedation. Use Caution/Monitor.

              • methadone

                dexmedetomidine and methadone both increase sedation. Use Caution/Monitor.

              • methamphetamine

                dexmedetomidine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methocarbamol

                dexmedetomidine and methocarbamol both increase sedation. Use Caution/Monitor.

              • methylenedioxymethamphetamine

                dexmedetomidine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • midazolam

                midazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • midazolam intranasal

                dexmedetomidine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

                midazolam intranasal, dexmedetomidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • midodrine

                dexmedetomidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mirtazapine

                dexmedetomidine and mirtazapine both increase sedation. Use Caution/Monitor.

              • modafinil

                dexmedetomidine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • morphine

                dexmedetomidine and morphine both increase sedation. Use Caution/Monitor.

              • motherwort

                dexmedetomidine and motherwort both increase sedation. Use Caution/Monitor.

              • moxonidine

                dexmedetomidine and moxonidine both increase sedation. Use Caution/Monitor.

              • nabilone

                dexmedetomidine and nabilone both increase sedation. Use Caution/Monitor.

              • nalbuphine

                dexmedetomidine and nalbuphine both increase sedation. Use Caution/Monitor.

              • norepinephrine

                dexmedetomidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                dexmedetomidine and nortriptyline both increase sedation. Use Caution/Monitor.

              • olanzapine

                dexmedetomidine and olanzapine both increase sedation. Use Caution/Monitor.

              • oliceridine

                dexmedetomidine, oliceridine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • opium tincture

                dexmedetomidine and opium tincture both increase sedation. Use Caution/Monitor.

              • orphenadrine

                dexmedetomidine and orphenadrine both increase sedation. Use Caution/Monitor.

              • oxazepam

                oxazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • oxycodone

                dexmedetomidine and oxycodone both increase sedation. Use Caution/Monitor.

              • oxymorphone

                dexmedetomidine and oxymorphone both increase sedation. Use Caution/Monitor.

              • paliperidone

                dexmedetomidine and paliperidone both increase sedation. Use Caution/Monitor.

              • papaveretum

                dexmedetomidine and papaveretum both increase sedation. Use Caution/Monitor.

              • papaverine

                dexmedetomidine and papaverine both increase sedation. Use Caution/Monitor.

              • passion flower

                passion flower increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

              • pentazocine

                dexmedetomidine and pentazocine both increase sedation. Use Caution/Monitor.

              • pentobarbital

                pentobarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • perphenazine

                dexmedetomidine and perphenazine both increase sedation. Use Caution/Monitor.

              • phendimetrazine

                dexmedetomidine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenobarbital

                phenobarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • phentermine

                dexmedetomidine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenylephrine

                dexmedetomidine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenylephrine PO

                dexmedetomidine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • pholcodine

                dexmedetomidine and pholcodine both increase sedation. Use Caution/Monitor.

              • pimozide

                dexmedetomidine and pimozide both increase sedation. Use Caution/Monitor.

              • pirbuterol

                dexmedetomidine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • primidone

                primidone and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • prochlorperazine

                dexmedetomidine and prochlorperazine both increase sedation. Use Caution/Monitor.

              • promethazine

                promethazine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • propofol

                propofol and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • propylhexedrine

                dexmedetomidine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                dexmedetomidine and protriptyline both increase sedation. Use Caution/Monitor.

              • quazepam

                quazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • quetiapine

                dexmedetomidine and quetiapine both increase sedation. Use Caution/Monitor.

              • ramelteon

                dexmedetomidine and ramelteon both increase sedation. Use Caution/Monitor.

              • risperidone

                dexmedetomidine and risperidone both increase sedation. Use Caution/Monitor.

              • salmeterol

                dexmedetomidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • scullcap

                dexmedetomidine and scullcap both increase sedation. Use Caution/Monitor.

              • secobarbital

                secobarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • sevoflurane

                sevoflurane and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • shepherd's purse

                dexmedetomidine and shepherd's purse both increase sedation. Use Caution/Monitor.

              • sufentanil

                dexmedetomidine and sufentanil both increase sedation. Use Caution/Monitor.

              • tamoxifen

                dexmedetomidine, tamoxifen. affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. CYP2D6 inhibition decreases metabolism of tamoxifen to hydroxytamoxifen, and N-desmethyl tamoxifen to endoxifen (active metabolites with 100-fold greater affinity for estrogen receptor); decreased endoxifen levels may result in poor clinical outcome.

              • tamsulosin

                dexmedetomidine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • tapentadol

                dexmedetomidine and tapentadol both increase sedation. Use Caution/Monitor.

              • tazemetostat

                dexmedetomidine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • temazepam

                temazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • terbutaline

                dexmedetomidine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • thioridazine

                dexmedetomidine and thioridazine both increase sedation. Use Caution/Monitor.

              • thiothixene

                dexmedetomidine and thiothixene both increase sedation. Use Caution/Monitor.

              • tinidazole

                dexmedetomidine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • topiramate

                dexmedetomidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tramadol

                dexmedetomidine and tramadol both increase sedation. Use Caution/Monitor.

              • trazodone

                dexmedetomidine and trazodone both increase sedation. Use Caution/Monitor.

              • triazolam

                triazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • triclofos

                dexmedetomidine and triclofos both increase sedation. Use Caution/Monitor.

              • trifluoperazine

                dexmedetomidine and trifluoperazine both increase sedation. Use Caution/Monitor.

              • trimipramine

                dexmedetomidine and trimipramine both increase sedation. Use Caution/Monitor.

              • triprolidine

                triprolidine and dexmedetomidine both increase sedation. Use Caution/Monitor.

              • valbenazine

                dexmedetomidine will increase the level or effect of valbenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Consider reducing valbenazine dose based on tolerability if coadministered with a strong CYP2D6 inhibitor.

              • valerian

                valerian increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

              • xylometazoline

                dexmedetomidine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • yohimbine

                dexmedetomidine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ziconotide

                dexmedetomidine and ziconotide both increase sedation. Use Caution/Monitor.

              • ziprasidone

                dexmedetomidine and ziprasidone both increase sedation. Use Caution/Monitor.

              • zotepine

                dexmedetomidine and zotepine both increase sedation. Use Caution/Monitor.

              Minor (7)

              • ashwagandha

                ashwagandha increases effects of dexmedetomidine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

              • brimonidine

                brimonidine increases effects of dexmedetomidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

              • eucalyptus

                dexmedetomidine and eucalyptus both increase sedation. Minor/Significance Unknown.

              • nettle

                nettle increases effects of dexmedetomidine by pharmacodynamic synergism. Minor/Significance Unknown. (High dose nettle; theoretical interaction) May enhance CNS depression.

              • ruxolitinib

                dexmedetomidine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sage

                dexmedetomidine and sage both increase sedation. Minor/Significance Unknown.

              • Siberian ginseng

                Siberian ginseng increases effects of dexmedetomidine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

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              Adverse Effects

              >10%

              Hypotension (25-28%)

              Hypertension (12-16%)

              Nausea (9-11%)

              1-10%

              Bradycardia (5-7%)

              Pyrexia (4-5%)

              Atrial fibrillation (4%)

              Dry mouth (3-4%)

              Vomiting (3-4%)

              Hypoxia (2-4%)

              Hypovolemia (3%)

              Atelectasis (3%)

              Tachycardia (2-3%)

              Postprocedural hemorrhage (2-3%)

              Anemia (2-3%)

              Agitation (2%)

              Hyperthermia (2%)

              Pain (2%)

              Hyperglycemia (2%)

              Chills or rigors (2%)

              Hyperglycemia (2%)

              Oliguria (2%)

              Thirst (2%)

              Acidosis (1-2%)

              Pleural effusion (1-2%)

              Pulmonary edema (1%)

              Hypocalcemia (1%)

              Urine output decreased (1%)

              Sinus tachycardia (1%)

              <1%

              Ventricular tachycardia

              Wheezing

              Peripheral edema

              Postmarketing Reports

              Blood and lymphatic system disorders: Anemia

              Cardiac disorders: Arrhythmia, atrial fibrillation, atrioventricular block, bradycardia, cardiac arrest, cardiac disorder, extrasystoles, myocardial infarction, supraventricular tachycardia, tachycardia, ventricular arrhythmia, ventricular tachycardia

              Eye disorders: Photopsia, visual impairment

              Gastrointestinal disorders: Abdominal pain, diarrhea, nausea, vomiting

              General: Chills, hyperpyrexia, pain, pyrexia, thirst

              Investigations: AST/ALT increased, blood alkaline phosphatase increased, blood urea increased, EKG T wave inversion, GGT increased, QT prolonged

              Metabolism and nutrition disorders: Acidosis, hyperkalemia, hypoglycemia, hypovolemia, hypernatremia

              Nervous system disorders: Convulsion, dizziness, headache, neuralgia, neuritis, speech disorder

              Psychiatric disorders: Agitation, confusional state, delirium, hallucination, illusion

              Renal and urinary disorders: Oliguria, polyuria

              Respiratory, thoracic, and mediastinal disorders: Apnea, bronchospasm, dyspnea, hypercapnia, hypoventilation, hypoxia, pulmonary congestion, respiratory acidosis

              Skin and subcutaneous tissue disorders: Hyperhidrosis, pruritus, rash, urticaria

              Surgical and medical procedures: Light anesthesia

              Vascular disorders: Blood pressure fluctuation, hemorrhage, hypertension, hypotension

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              Warnings

              Contraindications

              None

              Cautions

              Continuously monitor patients while on therapy; therapy should be administered only by persons skilled in the management of patients in the intensive care or operating room setting

              Bradycardia and sinus arrest have occurred in young healthy volunteers with high vagal tone or with different routes of administration, including rapid IV bolus administration

              Caution with advanced heart block and/or severe ventricular dysfunction; because dexmedetomidine decreases sympathetic nervous system activity, hypotension and/or bradycardia may be expected to be more pronounced in patients with hypovolemia, diabetes mellitus, or chronic hypertension, and in older patients

              Transient hypertension reported primarily during loading dose; consider reduction in loading infusion rate

              Patients can become aroused/alert with stimulation; this alone should not be considered as lack of efficacy

              Prolonged exposure to dexmedetomidine beyond 24 hours may be associated with tolerance and tachyphylaxis and a dose-related increase in adverse events (eg, ARDS, respiratory failure, agitation)

              Use with caution in hepatic impairment; consider dose reduction

              Hypotension and bradycardia may necessitate medical intervention; may be more pronounced in patients with hypovolemia, diabetes mellitus, or chronic hypertension, and in the elderly; use with caution in patients with advanced heart block or severe ventricular dysfunction

              Withdrawal symptoms after discontinuation reported when administered for longer than 6 hr; most common events reported include nausea, vomiting, and agitation

              Tachycardia and hypertension reported, requiring intervention 48 hr following study drug discontinuation; if tachycardia and/or hypertension occurs after discontinuation, supportive therapy is indicated

              Drug interaction overview

              • Caution if coadministered with other vasodilators or negative chronotropic agents owing to additive pharmacodynamic effects
              • Coadministration with anesthetics, sedatives, hypnotics, and opioids is likely to lead to an enhancement of pharmacodynamic effects
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              Pregnancy & Lactation

              Pregnancy

              There are no adequate and well-controlled studies of use in pregnant women

              In an in vitro human placenta study, placental transfer of dexmedetomidine occurred

              Animal studies

              • In pregnant rats, dexmedetomidine placental transfer observed when radiolabeled dexmedetomidine was administered SC
              • Thus, fetal exposure should be expected in humans; use during pregnancy only if potential benefits justify potential fetal risk

              Lactation

              Unknown if excreted in human milk

              Radio-labeled dexmedetomidine administered SC to lactating female rats was excreted in milk

              Because many drugs are excreted in human milk, caution should be exercised when administered to breastfeeding women

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Centrally acting alpha2-adrenoceptor agonist that has sedative and anesthetic properties possibly by activating G-proteins in the brainstem, which results in the inhibition of norepinephrine release

              Pharmacokinetics

              Half-life, elimination: 6 min; 2 hr (terminal)

              Peak plasma: 0.3-1.5 ng/mL

              Protein bound: 94%

              Vd: 118 L

              Metabolism: Liver, including glucuronidation and CYP2A6

              Metabolites: 3-hydroxy, 3-carboxy, 3-hydroxy N-methyl, 3-carboxy N-methyl, and N-methyl O-glucuronide dexmedetomidine

              Total body clearance: 39 L/hr

              Excretion: Urine (95%); feces (4%)

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              Administration

              IV Incompatibilities

              Y-site: amphotericin B, diazepam

              IV Compatibilities

              Solution: D5W, LR, 0.9% NaCl, mannitol 20%, MgSO4 100 mg/mL, KCl 0.3%

              Y-site (partial list): amiodarone, cefepime, cefoperazone, ceftriaxone, chlorpromazine, ciprofloxacin, clindamycin, digoxin, diphenhydramine, dobutamine, dopamine, epinephrine, fluconazole, furosemide, heparin, hydroxyzine, labetalol, lidocaine, linezolid, lorazepam, meperidine, metoclopramide, MgSO4, metronidazole, KCl, nitroglycerin, prochlorperazine, promethazine, NaHCO3, Na-nitroprusside, TMP-SMX, vancomycin, verapamil

              Not specified: atracurium, atropine, etomidate, fentanyl, glycopyrrolate, midazolam, mivacurium, morphine, pancuronium, phenylephrine, succinylcholine, thiopental, vecuronium

              IV Preparation

              200 mcg/2 mL (100 mcg/mL) vial

              • Must be diluted with 0.9% NaCl to achieve required concentration (4 mcg/mL) before
              • Preparation of solutions is the same, whether for the loading dose or maintenance infusion
              • Withdraw 2 mL of 100 mcg/mL dexmedetomidine and add to 48 mL of 0.9% NaCl to a total of 50 mL
              • Shake gently to mix well

              IV Administration

              Use controlled infusion device; use components made with synthetic or coated natural rubber gaskets

              Infuse loading dose over 10 min

              Maintenance dose: Administer by IV continuous infusion at recommended rate; individualized infusion rte and adjust rate to desired clinical response

              Storage

              Controlled room temperature of 25ºC (77ºF); excursions allowed from 15-30ºC (59-86ºF)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Precedex intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial
              dexmedetomidine intravenous
              -
              		100 mcg/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              dexmedetomidine intravenous

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Create Your List of Plans

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              View explanations for tiers and restrictions
              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.
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