DEXMEDETOMIDINE HYDROCHLORIDE
(dex-med-e-to¢mi-deen)
Precedex
Classifications: AUTONOMIC NERVOUS SYSTEM AGENT; ALPHA2-ADRENERGIC AGONIST (SYMPATHETOMIMETIC); SEDATIVE-HYPNOTIC
Prototype: Methoxamine Hydrochloride
Pregnancy category: CAVAILABILITY
100 mcg/mL in 2 mL ampule or vial
ACTIONS/THERAPEUTIC EFFECTS
A selective alpha-2 adrenergic agonist with sedative properties. Dexmedetomidine stimulates alpha-2 adrenergic receptors in the CNS (primarily in the medulla oblongata) causing inhibition of the sympathetic vasomotor center of the brain. Its sedative properties are utilized in intubating patients and for initially maintaining them on a mechanical ventilator. Hemodynamic responses of the heart affected by alpha-2 receptors are better controlled with dexmedetomidine than with other related drugs (e.g. midazolam).
USES
Sedation of initially intubated or mechanically ventilated patients.
ROUTE & DOSAGE
Sedation
Adult: IV start with 1 mcg/kg infused over 10 min, then continue with infusion of 0.2-0.7 mcg/kg/hr for up to 24 h. May need to decrease dosage in patients with renal or hepatic impairment.
PHARMACOKINETICS
Distribution: Half-life 6 min. Metabolism: Extensively metabolized in the liver (CYP 2A6). Elimination: Half-life 2 h; primarily excreted in urine.
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.
- Store at 15-30°C (59-86°F).
CONTRAINDICATIONS
Hypersensitivity to dexmedetomidine; labor and delivery, including Cesarean Section. PRECAUTIONS
Patients with arrhythmias or cardiovascular disease; renal or hepatic insufficiency; signs of light anesthesia; pregnancy (category C); lactation; elderly >65 y. Safety & efficacy in children <18 y are unknown.
ADVERSE EFFECTS
Body as Whole: Pain, infection. CV: Hypotension, bradycardia, atrial fibrillation. GI: Nausea, thirst. Respiratory: Hypoxia, pleural effusion, pulmonary edema. Other: Anemia, leukocytosis, oliguria.
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.
