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 March 18, 2025 - 5:05pm

Alternate Name(s): 
Precedex
Classification: 
Alpha-adrenergic agonist, sedative
Original Date: 
April 2019
Revised Date: 
May 2024
Indications: 
  • Sedation of newborn infants receiving mechanical ventilation
  • Adjunct to therapeutic hypothermia in hypoxic ischemic encephalopathy (HIE)
  • Opioid-sparing agent during opioid tapering 
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.

  • Therapeutic hypothermia: Start at a low dose as per HIE protocol, titrate dose in 0.1 mcg/kg/hr increments based on pain scores up to 0.4 mcg/kg/hr.

Weaning:

  • Wean by 0.1 mcg/kg/hr every 6 - 24 hours as tolerated.
  • Consider cross-taper to clonidine if needed 
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- (NPASS, WAT scores as applicable)
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, ketamine, pantoprazole

Notes: 
  • Long-term neurologic and neurodevelopmental outcomes, especially in premature infants, are still under study
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

  • Cosnahan, A. S., Angert, R. M., Jano, E., & Wachtel, E. V. (2021). Dexmedetomidine versus intermittent morphine for sedation of neonates with encephalopathy undergoing therapeutic hypothermia. Journal of perinatology : official journal of the California Perinatal Association, 41(9), 2284–2291. https://doi.org/10.1038/s41372-021-00998-8

  • McAdams, R. M., Pak, D., Lalovic, B., Phillips, B., & Shen, D. D. (2020). Dexmedetomidine Pharmacokinetics in Neonates with Hypoxic-Ischemic Encephalopathy Receiving Hypothermia. Anesthesiology research and practice, 2020, 2582965. https://doi.org/10.1155/2020/2582965

  • Nakauchi, C., Miyata, M., Kamino, S., Funato, Y., Manabe, M., Kojima, A., Kawai, Y., Uchida, H., Fujino, M., & Boda, H. (2023). Dexmedetomidine versus fentanyl for sedation in extremely preterm infants. Pediatrics international : official journal of the Japan Pediatric Society, 65(1), e15581. https://doi.org/10.1111/ped.15581

  • Trissel's™ 2 Clinical Pharmaceutics Database. IV Compatibility: Dexmedetomidine hydrochloride. Accessed Jan 2024.
    Cortes-Ledesma, C., Arruza, L., Sainz-Villamayor, A., & Martínez-Orgado, J. (2023). Dexmedetomidine affects cerebral activity in preterm infants. Archives of disease in childhood. Fetal and neonatal edition, 108(3), 316–318. https://doi.org/10.1136/archdischild-2021-323411

Special thanks to pharmacy student Claire Butler for work on this monograph.

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