dexmedetomidine (Rx)

Brand and Other Names:Precedex
  • Print

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 100mcg/mL
more...

ICU Sedation

Load: 1 mcg/kg IV over 10 minutes 

Maintenance 0.2-1.4 mcg/kg/hr IV

Titrate less frequently than q30min to prevent hypotension

Fiberoptic Intubation

Load: 1 mcg/kg IV over 10 minutes 

Maintenance 0.7 mcg/kg/hr IV

Procedural Sedation

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) 

Titrate less frequently than q30min to prevent hypotension

Renal Impairment

Dose reduction may be required

Hepatic Impairment

Dose reduction may be required

Safety and efficacy not established

Load: 0.5 mcg/kg IV over 10 minutes

Next:

Interactions

Interaction Checker

and dexmedetomidine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            >10%

            Hypotension (28%)

            1-10%

            AFib

            Anemia

            Bradycardia

            Fever

            Pleural effusion

            Leukocytosis

            Pulmonary edema

            Postmarketing Reports

            Electrocardiogram QT prolonged

            Hypernatremia

            Polyuria

            Acute renal failure

            Respiratory distress syndrome

            Respiratory failure

            Previous
            Next:

            Warnings

            Contraindications

            Hypersensitivity

            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 intravenous or bolus administration

            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

            Use with caution with concomitant administration of other vasodilators or negative chronotropic agents; use with caution due to additive pharmacodynamic effects

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

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

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Excretion in milk unknown; use with caution

            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.

            more...
            Previous
            Next:

            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%)

            Previous
            Next:

            Administration

            IV Incompatibilities

            Y-site: ampho B, diazepam

            IV Compatibilities

            Solution: D5W, LR, NS, mannitol 20%

            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, nitroglycein, prochlorperazine, promethazine, NaHCO3, Na-nitroprusside, TMP-SMX, vancomycin, verapamil

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

            IV Preparation

            Dilute in NS

            IV Administration

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

            Infuse loading dose over 10 min

            Previous
            Next:

            Images

            Previous
            Next:

            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.

            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.

            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.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.