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DEXMEDETOMIDINE HYDROCHLORIDE

Medical Diagnosis and Drugs, Medications
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

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