Home Drug Guide Dexmedetomidine Hydrochloride

Drug Guide

Generic Name

Dexmedetomidine Hydrochloride

Brand Names Precedex, Igalmi

Classification

Therapeutic: Sedative, Analgesic

Pharmacological: Alpha-2 Adrenergic Agonist

FDA Approved Indications

  • Sedation of initially intubated and mechanically ventilated patients in intensive care settings
  • Sedation of non-intubated patients undergoing procedures (Precedex)
  • Management of alcohol withdrawal symptoms (Igalmi)

Mechanism of Action

Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist that induces sedation by inhibiting norepinephrine release, producing a sedative, anxiolytic, and analgesic effect without significant respiratory depression.

Dosage and Administration

Adult: For ICU sedation: typically 0.2-0.7 mcg/kg/hr infusion, titrated to desired sedation level. For procedures: bolus of 1 mcg/kg over 10 minutes followed by infusion.

Pediatric: Adjust dosing based on weight and clinical condition, typically similar infusion protocols.

Geriatric: Start at lower doses due to increased sensitivity; usual infusion rates with careful titration.

Renal Impairment: Use cautiously; no specific dose adjustment, monitor closely.

Hepatic Impairment: Use cautiously; no specific dose adjustment, monitor closely.

Pharmacokinetics

Absorption: Absorbed rapidly and nearly completely intravenously.

Distribution: Volume of distribution approximately 118 L after IV administration.

Metabolism: Metabolized primarily in the liver via direct glucuronidation and CYP450 enzymes (mainly CYP2A6).

Excretion: Excreted mainly as metabolites in urine and feces.

Half Life: 2 to 3 hours

Contraindications

  • Hypersensitivity to dexmedetomidine or any component of the formulation.

Precautions

  • Use with caution in patients with conduction abnormalities, hypotension, or bradycardia. Monitor cardiovascular status; risk of hypotension and bradycardia. Use in pregnancy only if clearly indicated; safety during lactation not established.

Adverse Reactions - Common

  • Hypotension (Common)
  • Bradycardia (Common)
  • Nausea (Less common)
  • Dry mouth (Less common)

Adverse Reactions - Serious

  • Severe hypotension or bradycardia requiring intervention (Rare)
  • Cardiac arrest (Rare)

Drug-Drug Interactions

  • CYP450 inhibitors or inducers may alter metabolism.
  • Other sedatives or CNS depressants may enhance sedative effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor vital signs continuously, especially blood pressure and heart rate. Assess sedation levels.

Diagnoses:

  • Ineffective airway clearance (due to sedation)
  • Risk for hypotension
  • Risk for bradycardia

Implementation: Administer dose as per protocol, titrate based on clinical response. Use infusion pump for accurate delivery. Monitor for adverse effects.

Evaluation: Regularly assess sedation depth, cardiovascular status, and respiratory function.

Patient/Family Teaching

  • Explain that sedation will be monitored closely. Warn about potential for low blood pressure and slow heart rate. Do not adjust infusion rate without medical guidance.

Special Considerations

Black Box Warnings:

  • Potential for hypotension and bradycardia, which can be serious. Continuous monitoring is essential.

Genetic Factors: None specific.

Lab Test Interference: May affect liver function tests due to hepatic metabolism.

Overdose Management

Signs/Symptoms: Hypotension, bradycardia, excessive sedation, possibly unresponsiveness.

Treatment: Discontinue infusion immediately. Provide supportive care, including IV fluids, atropine for bradycardia, or vasopressors for hypotension. Resuscitation equipment should be available.

Storage and Handling

Storage: Store at controlled room temperature (20-25°C / 68-77°F).

Stability: Stable for the duration specified on the package, typically used within 24 hours once prepared. Avoid freezing.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.