Parenteral Manual

Dexmedetomidine HCL

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
PRECEDEX
Classification: 
Alpha-adrenergic agonist, sedative
Original Date: 
December 2008
Revised Date: 
March 2020
Indications: 
  • Sedation of intubated and mechanically ventilated patients in an intensive care setting
    (OR and PICU)

 

Reconstitution and Stability: 
  • Available as 4 mcg/mL vials - 50 and 100 mL
  • Store vials at room temperature
  • May adsorb to certain types of natural rubber; use components made with synthetic or coated natural rubber gaskets whenever possible
Compatibility: 

-Solutions Compatible:  0.9% NaCl

-Additives/Above Cassette Compatible:  no information

-Y-site Compatible:  D5W, LR, amiodarone, ampicillin, calcium gluconate, cefazolin, clindamycin, dobutamine, dopamine, esmolol, fentanyl, furosemide, heparin, hydromorphone, ketorolac,  labetalol, lorazepam, magnesium sulfate, methylprednisolone,  midazolam, milrinone, morphine, norepinephrine, ondansetron, ranitidine, TPN (Amino Acids/Dextrose, SMOF), vancomycin

-Incompatible:  amphotericin B, diazepam

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion YES
Usual dilution:  4 mcg/mL
Infusion time:  10 minutes
IV Continuous Infusion

YES
Standard Conce

ntration in PICU/OR:  4 mcg/mL

Click here to access SDC Drug Infusion Sheet

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  • Loading Dose:  0.5 - 1 mcg/kg/dose over  10 minutes
  • Maintenance Dose:  0.2 - 0.7 mcg/kg/hr

Adults:

  • 1 mcg/kg/dose over 10 minutes
  • Maintenance Dose:  0.2 - 0.7 mcg/kg/hr

Note:  the manufacturer does not recommend that the duration of treatment  exceed 24 hours; however, there have been a few studies demonstrating that dexmedetomidine was well tolerated in treatment periods > 24 hours;  titrate infusion rate so patient awakens slowly;  abrupt discontinuation, particularly after prolonged infusions may result in withdrawal symptoms

Potential hazards of parenteral administration: 
  • Cardiovascular:  hypotension (28%), hypertension (16%), bradycardia, atrial fibrillation, tachycardia
  • CNS:  pain, fever, agitation, dizziness
  • Endocrine/Metabolic:  hyperglycemia, acidosis, hyperkalemia
  • GI:  nausea (11%), xerostomia, abdominal pain, diarrhea, vomiting
  • Respiratory:  hypoxia, pulmonary edema, pleural effusion, respiratory acidosis, apnea, bronchospasm, dyspneahypercapnia, hypoventilation, pulmonary congestion

 

Notes: 
  • Bradycardia and sinus arrest have been associated with rapidly given administration (eg. bolus doses) or to patients with high vagal tone .
  • Hypotension and bradycardia have been associated with infusion.  Treatment may include decreasing the infusion rate, atropine, administration of fluids, pressors, elevation of extremeties
  • Transient hypertension primarily observed during the loading dose in association with the initial periperal vasoconstrictive effects.  Treatment is usually not necessary, however, a reduction in infusion rate may be done.
  • Should be administered only by persons skilled in the management of patients in the intensive care setting.  Patients should be continuously monitored.
References: 

- Campos-Baeta Y, Saavedra-Mitjans M, Garin N, Cardenete J, Cardona D, Riera P.  Physiochemical Compatibility of Dexmedetomidine With Parenteral Nutrition.  Nutr Clin Pract. 2019;00:1-6

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