- Sedation and analgesia of newborn infants receiving mechanical ventilation
- IV continuous infusion
- 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
- CVS: bradycardia, hypotension, transient tachycardia
- Withdrawal symptoms (tachycardia, hypertension, elevated NAS scores) if wean too quickly after receiving more than 24 hours infusion
- HR, BP
- Level of sedation
- Use the 4 mcg/mL - 20 or 50 mL prefilled syringe prepared by pharmacy
- 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
- 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