Dexmedetomidine: Indication, Dosage, Side Effect, Precaution

This information is not country-specific. Please refer to the Myanmar prescribing information.

Generic Medicine Info

Indications and Dosage

Intravenous
Sedation in critical care

Adult: 0.7 mcg/kg/hr adjusted according to response, w/in the dose range 0.2-1.4 mcg/kg/hr.

Reconstitution

Dilute to a concentration of 4 mcg/mL in glucose 5%, Ringer's, mannitol or NaCl 0.9% soln for inj.

Incompatibility

Incompatible w/ amphotericin B and diazepam.

Contraindications

2nd or 3rd degree AV block (unless paced), uncontrolled hypotension, acute cerebrovascular disorders.

Special Precautions

Patient w/ severe neurological disorders, pre-existing bradycardia, ischaemic heart disease, spinal cord injury, malignant hyperthermia. Avoid abrupt withdrawal after prolonged use. Hepatic and renal impairment. Pregnancy and lactation.

Adverse Reactions

Nausea, vomiting, dry mouth, BP changes, bradycardia, tachycardia, AF, MI, myocardial ischaemia, fever, hypoxia, hyperthermia, anaemia, agitation, pain, pleural effusion, changes in blood sugar.

Pregnancy Category (US FDA)

IV/Parenteral: C

Monitoring Parameters

Monitor cardiac and resp function, level of sedation, pain control.

Overdosage

Symptoms: Bradycardia, hypotension, oversedation, somnolence, cardiac arrest. Management: Treat sinus arrest w/ atropine and glycopyrrolate. Resuscitation was needed in isolated cases of severe overdose resulting in cardiac arrest.

Drug Interactions

Enhanced pharmacologic effects of anaesth, sedatives, hypnotics, opiate agonists, other vasodilators or drugs that have negative chronotropic effects (e.g. cardiac glycosides).

Action

Description: Dexmedetomidine is a selective α₂-adrenoceptor agonist w/ anaesth and sedative properties. Its action is thought to be due to activation of G-proteins by α_2a-adrenoceptors in the brainstem resulting in inhibition of norepinephrine release.
Onset: 5-10 min.
Duration: 60-120 min.
Pharmacokinetics:
Absorption: Time to peak plasma concentration: 15-30 min.
Distribution: Plasma protein binding: Approx 94%.
Metabolism: Almost completely metabolised via direct N-glucuronidation, N-methylation or aliphatic hydroxylation by CYP2A6 isoenzyme.
Excretion: Via urine (95%) and faeces (4%) mainly as metabolites. Terminal elimination half-life: Approx 2 hr.

Storage

Store at 25°C.

MIMS Class

Hypnotics & Sedatives

References

Anon. Dexmedetomidine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/08/2014.

Buckingham R (ed). Dexmedetomidine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/08/2014.

Joint Formulary Committee. Dexmedetomidine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/08/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Dexmedetomidine Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 11/08/2014.

Precedex Injection Solution (Hospira). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 11/08/2014.

Precedex Injection. U.S. FDA. https://www.fda.gov/. Accessed 11/08/2014.

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