Dexmedetomidine parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Infusions of dexmedetomidine.
Drugs List
Therapeutic Indications
Uses
Sedation for surgical and diagnostic procedures
Sedation of patients receiving intensive care
Sedation of adult ICU patients requiring a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale (RASS) 0 to -3).
Sedation of non-intubated adult patients for diagnostic or surgical procedures.
Dosage
Adults
Sedation of adult intensive care unit (ICU) patients requiring a sedation level not deeper than arousal in response to verbal stimulation
Initial dose: 0.7 microgram/kg/hour.
Adjusted stepwise within the dose range of 0.2 to 1.4 microgram/kg/hour to achieve the desired level of sedation, depending on the patient's response.
The maximum dose of 1.4 micrograms/kg/hour should not be exceeded. Patients failing to achieve an adequate level of sedation with the maximum dose of dexmedetomidine should be switched to an alternative sedative agent.
A lower starting infusion rate should be considered for frail patients.
After dose adjustment, a new steady state sedation level may not be reached for up to one hour.
Use of a loading dose of dexmedetomidine in ICU sedation is not recommended.
There is no experience in the use of dexmedetomidine for more than 14 days. The use of dexmedetomidine for longer than this period should be regularly reassessed.
Sedation of non-intubated adult patients for diagnostic or surgical procedures
Initial dose: a loading dose of 1 microgram/kg over 10 minutes.
For less invasive procedures, a loading dose of 0.5 microgram/kg over 10 minutes.
Maintenance dose: 0.6 to 0.7 microgram/kg/hour, titrated within the dose range of 0.2 to 1 microgram/kg/hour.
Administration
For administration as an intravenous infusion using a controlled infusion device.
Some formulations will require dilution before use.
Contraindications
Children under 18 years
Acute cerebrovascular disorder
Breastfeeding
Non-paced second degree atrioventricular block
Non-paced third degree atrioventricular block
Severe hypotension
Precautions and Warnings
Elderly
Predisposition to malignant hyperthermia
Bradycardia
Cardiovascular disorder
Central nervous system surgery
Cerebrovascular disorder
Head trauma
Hepatic impairment
Hypotension
Hypovolaemia
Ischaemic heart disease
Pregnancy
Reduced respiratory reserve
Severe neurological disorder
Advise patient ability to drive or operate machinery may be impaired
Some formulations contain glucose
Administration carried out in centres with intensive care facilities
Some formulations must be diluted before use
Treatment to be administered under the supervision of a specialist
Monitor blood pressure
Monitor cardiac function
Monitor respiratory function
Discontinue in patients with unexplained high fever
Withdrawal symptoms after long-term normal use on abrupt cessation
Consider dose reduction/discontinuation if cerebral ischaemia occurs
Consider dose reduction/discontinuation if myocardial ischaemia occurs
Not suitable for patients requiring continuous deep sedation, as patients are normally easily roused whilst on dexmedetomidine.
Alternative sedative treatment is required for acute control of agitation or during procedures, especially during the first few hours of treatment.
Pregnancy and Lactation
Pregnancy
Use dexmedetomidine with caution during pregnancy.
The manufacturer recommends that dexmedetomidine should not be used during pregnancy unless the clinical condition requires the use of dexmedetomidine. At the time of writing, there is limited published information data from the use of dexmedetomidine in pregnant women. Animals studies have shown reproductive toxicity.
Lactation
Dexmedetomidine is contraindicated during breastfeeding.
The manufacturer recommends that either breastfeeding or dexmedetomidine therapy should be discontinued, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the mother. Available data have shown that dexmedetomidine is excreted in breast milk, and a risk to infants cannot be excluded.
Side Effects
Abdominal distension
Agitation
Apnoea
Bradycardia
Decreased cardiac output
Dry mouth
Dyspnoea
First degree AV block
Hallucinations
Hyperglycaemia
Hypertension
Hyperthermia
Hypoalbuminaemia
Hypoglycaemia
Hypotension
Metabolic acidosis
Myocardial infarction
Myocardial ischaemia
Nausea
Respiratory depression
Tachycardia
Thirst
Vomiting
Withdrawal symptoms
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: September 2015
Reference Sources
Summary of Product Characteristics: Dexdor 100micrograms/ml concentrate for solution for infusion. Orion Pharma (UK) Limited. Revised June 2015.
Summary of Product Characteristics: Dexmedetomidine 4 micrograms/ml solution for infusion. Altan Pharma Ltd. Revised April 2020.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 03 December 2021
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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