Neonatal Drug Therapy Manual

Dexmedetomidine

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

Updated April 21, 2021 - 12:00am

Alternate Name(s): 
Precedex
Classification: 
Alpha-adrenergic agonist, sedative
Original Date: 
April 2019
Revised Date: 
March 2020
Indications: 
  • Sedation and analgesia of newborn infants receiving mechanical ventilation
Administration: 
  • IV continuous infusion
Dosage: 
  • Initial dose: 0.2 - 0.3 mcg/kg/hr.  Titrate dose in 0.1 mcg/kg/hr increments every 30 - 60 minutes to a maximum of 0.7 mcg/kg/hr.
  • Maintenance doses as high as 1 mcg/kg/hr have been used in infants and older children.

Weaning:

  • Wean by 0.1 mcg/kg/hr every 12 - 24 hours as tolerated.
  • Consider switching to clonidine once at a lower dexmedetomidine rate
Side Effects: 
  • CVS: bradycardia, hypotension, transient tachycardia
  • Withdrawal symptoms (tachycardia, hypertension, elevated NAS scores) if wean too quickly after receiving more than 24 hours infusion
Parameters to Monitor: 
  • HR, BP
  • Level of sedation
Reconstitution and Stability: 
  • Use the 4 mcg/mL - 20 or 50 mL prefilled syringe prepared by pharmacy
Compatibility: 

- Solutions Compatible: 0.9% NaCl

- Y-site Compatible: ampicillin, cefazolin, cefotaxime, dexamethasone, dobutamine, dopamine, epinephrine, fentanyl, furosemide, heparin, hydromorphone, lorazepam, milrinone, morphine, norepinephrine, ranitidine, rocuronium, sodium bicarbonate, tobramycin, SMOF, TPN (Amino Acids/Dextrose), vancomycin

- Incompatible: amphotericin B, diazepam

References: 

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

- Dersch-Mills DA, Banasch HL, Yusuf K, Howlett A.  Dexmedetomidine Use in a Tertiary Care NICU: A Descriptive Study.  Ann Pharmacother. 2018;1-7. doi : 10.1177/1060028018812089

- Taketomo CK, Hodding JH, Kraus DM.  Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015

- American Society on Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19th Edition. Bethesda: ASHP 2017

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