Dexmedetomidine

Dexmedetomidine Brand Name– Precedex

What is Dexmedetomidine

Dexmedetomidine is a relatively selective alpha₂-adrenoceptor agonist with centrally mediated sympatholytic, sedative, and analgesic effects. In general, dexmedetomidine has similar pharmacological effects to clonidine, another alpha₂-adrenoceptor agonist.

Dexmedetomidine infusions are used for sedation in the treatment of mechanically ventilated patients in an intensive care setting or for sedation of non-intubated patients prior to and/or during surgical or other procedures.

Dexmedetomidine has been administered to mechanically ventilated patients prior to extubation, during extubation, and post-extubation.

During perioperative use, dexmedetomidine has reduced anesthetic or opioid dosage requirements similar to midazolam, but its use may require vasopressor and/or anticholinergic support to maintain blood pressure and heart rate goals.

Infusion of dexmedetomidine benefited perioperative hemodynamic management of surgical patients at high cardiovascular risk undergoing vascular surgery but required greater intraoperative pharmacologic intervention to support blood pressure and heart rate.

Indications

1. preanesthesia
2. procedural sedation
3. sedation induction
4. sedation maintenance

For sedation induction and sedation maintenance of initially intubated and mechanically ventilated intensive care patients

Side Effects

1. abdominal pain
2. acute respiratory distress syndrome (ARDS)
3. adrenocortical insufficiency
4. agitation
5. anemia
6. anxiety
7. apnea
8. arrhythmia exacerbation
9. atrial fibrillation
10. AV block
11. bleeding
12. bradycardia
13. bronchospasm
14. cardiac arrest
15. chills
16. confusion
17. constipation
18. delirium
19. diaphoresis
20. diarrhea
21. dizziness
22. dyspnea
23. edema
24. elevated hepatic enzymes
25. fever
26. hallucinations
27. headache
28. hyperbilirubinemia
29. hyperglycemia
30. hyperhidrosis
31. hyperkalemia
32. hypernatremia
33. hypertension
34. hyperthermia
35. hypocalcemia
36. hypoglycemia
37. hypokalemia
38. hypomagnesemia
39. hypotension
40. hypoventilation
41. hypovolemia
42. hypoxia
43. lethargy
44. myocardial infarction
45. nausea
46. neuritis
47. oliguria
48. peripheral edema
49. photopsia
50. pleural effusion
51. polydipsia
52. polyuria
53. pruritus
54. pulmonary edema
55. QT prolongation
56. rash
57. renal failure (unspecified)
58. respiratory depression
59. seizures
60. sinus tachycardia
61. supraventricular tachycardia (SVT)
62. tolerance
63. urticaria
64. ventricular tachycardia
65. visual impairment
66. vomiting
67. wheezing
68. withdrawal
69. xerostomia

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• abrupt discontinuation
• AV block
• bradycardia
• breast-feeding
• cardiac disease
• children
• diabetes mellitus
• dialysis
• geriatric
• hepatic disease
• hypertension
• hypotension
• hypovolemia
• infants
• labor
• neonates
• obstetric delivery
• pregnancy
• renal disease
• renal failure
• renal impairment
• requires a specialized care setting
• requires an experienced clinician
• sick sinus syndrome
• ventricular dysfunction

Interactions

• Acebutolol
• Acetaminophen; Tramadol
• Anxiolytics; Sedatives; and Hypnotics
• Atenolol
• Atenolol; Chlorthalidone
• Barbiturates
• Bendroflumethiazide; Nadolol
• Benzodiazepines
• Beta-blockers
• Betaxolol
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Brimonidine; Timolol
• Buprenorphine
• Buprenorphine; Naloxone
• Calcium-channel blockers
• Cannabidiol
• Cardiac glycosides
• Carteolol
• Carvedilol
• Cenobamate
• Cetirizine
• Cetirizine; Pseudoephedrine
• Deutetrabenazine
• Diazoxide
• Digitoxin
• Digoxin
• Dorzolamide; Timolol
• Droperidol
• Esketamine
• Esmolol
• Ethanol
• Fenoldopam
• Gabapentin
• General anesthetics
• Hydralazine
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydralazine; Isosorbide Dinitrate, ISDN
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Propranolol
• Labetalol
• Lasmiditan
• Levobetaxolol
• Levobunolol
• Levocetirizine
• Lumateperone
• Methocarbamol
• Metoprolol
• Minoxidil
• Nadolol
• Nebivolol
• Nebivolol; Valsartan
• Nesiritide, BNP
• Nitroprusside
• Opiate Agonists
• Penbutolol
• Phenothiazines
• Pindolol
• Pregabalin
• Propranolol
• Sedating H1-blockers
• Skeletal Muscle Relaxants
• Sotalol
• Timolol
• Tizanidine
• Tramadol
• Treprostinil
• Vasodilators