Dexmedetomidine

ICU Sedation, Fiberoptic Intubation, Procedural Sedation

ICU Sedation Load: 1 mcg/kg IV over 10 minutes Maintenance 0.2-1.4 mcg/kg/hr IV Titrate less frequently than q30min to prevent hypotension Fiberoptic Intubation Load: 1 mcg/kg IV over 10 minutes Maintenance 0.7 mcg/kg/hr IV Procedural Sedation Load: 1 mcg/kg IV over 10 minutes Maintenance 0.6 mcg/kg/hr IV titrate to effect (usually 0.2-1 mcg/kg/hr) Titrate less frequently than q30min to prevent hypotension

Safety and efficacy not established

Renal impairment (SL, BUC) All severities: No dosage adjustment necessary

Geriatric patients (age greater than 65 years): Consider a dose reduction for ICU sedation. Recommended loading infusion dosage for initiation of procedural sedation is 0.5 mcg/kg over 10 minutes. Consider dosage reduction for maintenance of procedural sedation.

Hepatic impairment (SL, BUC) Mild or moderate (Child-Pugh A or B) Mild or moderate agitation: 90 mcg SL initially; if agitation persists, may give 60 mcg for up to 2 doses at least 2 hr apart; not to exceed 210 mcg/day Severe agitation: 120 mcg SL initially; if agitation persists, may give 60 mcg for up to 2 doses at least 2 hr apart; not to exceed 240 mcg/day Severe (Child-Pugh C) Mild or moderate agitation: 60 mcg SL initially; if agitation persists, may give 60 mcg for up to 2 doses at least 2 hr apart; not to exceed 180 mcg/day Severe agitation: 90 mcg SL initially; if agitation persists, may give 60 mcg for up to 2 doses at least 2 hr apart; not to exceed 210 mcg/day

IV Preparation Dilute in NS IV Administration Infuse loading dose over 10 min

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

Bradycardia and Sinus Arrest: Consider decreasing or stopping dexmedetomidine HCl infusion; decreasing or stopping other medications that depress sinus node function; administering anticholinergic agents (e.g., glycopyrrolate, atropine); and/or administering pressor agents. Hypotension: Consider decreasing or stopping dexmedetomidine HCl infusion; increasing rate of intravenous fluid administration; elevating lower extremities, and/or administering pressor agents. Transient Hypertension: Observed primarily during administration of loading dose. Consider reducing loading infusion rate. Arousability: Patients can become aroused/alert with stimulation; this alone should not be considered as lack of efficacy. Prolonged exposure to dexmedetomidine beyond 24 hours may be associated with tolerance and tachyphylaxis and a dose-related increase in adverse events.

Not Classi Pregnancy There are no adequate and well-controlled studies of use in pregnant women In an in vitro human placenta study, placental transfer of dexmedetomidine occurred Animal studies In pregnant rats, dexmedetomidine placental transfer observed when radiolabeled dexmedetomidine was administered SC Thus, fetal exposure should be expected in humans; use during pregnancy only if potential benefits justify potential fetal risk Lactation Unknown if excreted in human milk Radio-labeled dexmedetomidine administered SC to lactating female rats was excreted in milk Because many drugs are excreted in human milk, caution should be exercised when administered to breastfeeding women

Enhanced pharmacologic effects of anaesth, sedatives, hypnotics, opiate agonists, other vasodilators or drugs that have negative chronotropic effects (e.g. cardiac glycosides). Anesthetics, sedatives/hypnotics, opioids: Can potentiate sedating effects. Consider reducing dosage of dexmedetomidine HCl or co-administered drug. Contraindicated (1) eliglustat Serious (14) calcium/magnesium/potassium/sodium oxybates givinostat hydrocodone landiolol lonafarnib metoclopramide intranasal olopatadine intranasal ponesimod ropeginterferon alfa 2b sodium oxybate sufentanil SL valerian vortioxetine zuranolone

>10% Hypotension (25-28%) Hypertension (12-16%) Nausea (9-11%) 1-10% Bradycardia (5-7%) Pyrexia (4-5%) Atrial fibrillation (4%) Dry mouth (3-4%) Vomiting (3-4%) Hypoxia (2-4%) Hypovolemia (3%) Atelectasis (3%) Tachycardia (2-3%) Postprocedural hemorrhage (2-3%) Anemia (2-3%) Agitation (2%) Hyperthermia (2%) Pain (2%) Hyperglycemia (2%) Chills or rigors (2%) Hyperglycemia (2%) Oliguria (2%) Thirst (2%) Acidosis (1-2%) Pleural effusion (1-2%) Pulmonary edema (1%) Hypocalcemia (1%) Urine output decreased (1%) Sinus tachycardia (1%) <1% Ventricular tachycardia Wheezing Peripheral edema

Centrally acting alpha2-adrenoceptor agonist that has sedative and anesthetic properties possibly by activating G-proteins in the brainstem, which results in the inhibition of norepinephrine release.