II. Indications

  1. Post-Intubation Sedation and Analgesia
    1. Short-term sedation (<24 hours) in ICU patients on Mechanical Ventilation
    2. Tachyphylaxis occurs with use >24 hours
  2. Alcohol Withdrawal
  3. Peri-procedure sedation

III. Mechanism

  1. Selective central alpha-2-adrenergic agonist (similar to Clonidine) with sedative properties
  2. Brainstem G-Protein activation inhibits Norepinephrine release
    1. Decreases sympathetic tone and peripheral vascular resistance

IV. Advantages

  1. Offers sedation while allowing patients to maintain their airway, maintain respirations and respond
  2. Generic

V. Pharmacokinetics

  1. Onset: 10 minutes
  2. Duration: 1-2 hours
  3. Renal and hepatic metabolism

VI. Dosing

  1. Load: 1 mcg/kg in adults (0.5 to 1 mcg/kg in children) over 10 minutes, then
  2. Infusion: 0.2 to 0.7 mcg/kg/hour in adults (0.2 to 0.5 mcg in children)
    1. Titrate to desired level of sedation, modifying dose every 30 min to 0.2 to 1.5 mcg/kg/hour
    2. Decrease dosing in hepatic dysfunction and the elderly
  3. Reduce dose in over age 65 years or renal/hepatic Impairment

VII. Adverse Effects

  1. Severe Bradycardia
  2. Hypotension
    1. Transient Hypertension may occur with rapid infusion
  3. Dry Mouth

VIII. References

  1. Fisher and Fisher (2018) Crit Dec Emerg Med 32(1): 24
  2. Kay (2015) Crit Dec Emerg Med 29(8): 11-17

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Ontology: Dexmedetomidine (C0113293)

Definition (MSH) A imidazole derivative that is an agonist of ADRENERGIC ALPHA-2 RECEPTORS. It is closely-related to MEDETOMIDINE, which is the racemic form of this compound.
Definition (NCI) An imidazole derivate and active d-isomer of medetomidine with analgesic, anxiolytic and sedative properties. Dexmedetomidine selectively binds to presynaptic alpha-2 adrenoceptors located in the brain, thereby inhibiting the release of norepinephrine from synaptic vesicles. This leads to an inhibition of postsynaptic activation of adrenoceptors, which inhibit sympathetic activity, thereby leading to sedation and anxiolysis. The analgesic effect of this agent is mediated by binding to alpha-2 adrenoceptors in the spinal cord.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D020927
SnomedCT 438079000, 437750002
English (+)-4-((S)-alpha,2,3-Trimethylbenzyl)imidazole, 1H-Imidazole, 4-(1-(2,3-dimethylphenyl)ethyl)-, (R)-, Dexmedetomidine (substance), Dexmedetomidine (product), Dexmedetomidine, Dexmedetomidine [Chemical/Ingredient], DEXMEDETOMIDINE, dexmedetomidine
Swedish Dexmedetomidin
Czech dexmedetomidin
Finnish Deksmedetomidiini
Japanese プレセデックス, デキサメデトミジン, デキスメデトミジン, デクスメデトミジン塩酸塩, デクスメデトミジン, 塩酸デクスメデトミジン, D-メデトミジン
Spanish dexmedetomidina, Dexmedetomidina, Dexmedetomidina (sustancia), dexmedetomidina (producto)
Polish Deksmedetomidyna
French Dexmédétomidine
German Dexmedetomidin
Italian Dexmedetomidina
Portuguese Dexmedetomidina

Ontology: Precedex (C0876757)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D020927
English Hospira Brand of Dexmedetomidine Hydrochloride, Precedex, precedex

Ontology: Dexdomitor (C2732176)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
English Dexdomitor