dexmedetomidine (Precedex)

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Indications

* dexmedetomidine in patients with sepsis did not improve either ventilator-free days or 28-day mortality[7]

Contraindications

  • not indicated for infusions > 24 hours
  • no mortality benefit as sole sedating agent for critically ill patients[8]

Pregnancy category: C

Dosage

  • IV infusion
    • loading dose of 1 ug/kg over 10 minutes
    • maintenance 0.2-0.7 ug/kg/hour
    • consider dose reduction in the elderly
  • sublingual 120 ug, 180 ug[9]

Solution must be diluted with normal saline prior to administration

Pharmacokinetics

Monitor

pulse, respiration, rhythm, blood pressure, consciousness

Adverse effects

Drug interactions

Mechanism of action

More general terms

References

  1. UpToDate 13.2
  2. Venn M et al, Intensive Care Med 2003; 29:201 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12594584
  3. 3.0 3.1 3.2 Pandharipande PP et al, Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: The MENDS randomized controlled trial. JAMA 2007, 298:2644 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18073360
  4. Jakob SM et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: Two randomized controlled trials. JAMA 2012 Mar 21; 307:1151. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22436955
  5. 5.0 5.1 5.2 5.3 Reade MC et al. Effect of dexmedetomidine added to standard care on ventilator-free time in patients with agitated delirium: A randomized clinical trial. JAMA 2016 Apr 12; 315:1460. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26975647
    Ely EW, Pandharipande PP. The evolving approach to brain dysfunction in critically ill patients. JAMA 2016 Apr 12; 315:1455 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26976552
  6. 6.0 6.1 Su X, Meng ZT, Wu XH et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: A randomised, double-blind, placebo- controlled trial. Lancet 2016 Aug 16; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27542303
  7. 7.0 7.1 Kawazoe Y, Miyamoto K, Morimoto T et al Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis. A Randomized Clinical Trial. JAMA. 2017 Apr 4;317(13):1321-1328 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28322414 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2612911
  8. 8.0 8.1 Shehabi Y, Howe BD, Bellomo R et al. Early sedation with dexmedetomidine in critically ill patients. N Engl J Med 2019 May 19; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31112380 https://www.nejm.org/doi/10.1056/NEJMoa1904710
  9. 9.0 9.1 9.2 Preskorn SH, Zeller S, Citrome L et al Effect of Sublingual Dexmedetomidine vs Placebo on Acute Agitation Associated With Bipolar Disorder. A Randomized Clinical Trial. JAMA. 2022;327(8):727-736 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35191924 https://jamanetwork.com/journals/jama/fullarticle/2789315

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