Generic Name

Dexmedetomidine Hydrochloride

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Classification

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

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.