Dexmedetomidine [1 vial $70.00] ADMINISTRATION ROUTES:
ALTERNATIVE NAMES: Precedex
ICU INDICATIONS: 1. agitation
Note: – Dexmedetomidine is an expensive drug with a limited evidence base to support its use. It should only be administered with ICU Consultant authorisation.
PRESENTATION AND ADMINISTRATION:
200mcg/2ml vial Dexmedetomidine must be diluted in 0.9% sodium chloride solution prior to administration. Preparation of solutions is the same, whether for the loading dose or maintenance infusion. To prepare the infusion, withdraw 2 ml of dexmedetomidine and add to 48 ml of 0.9% sodium chloride injection to a total of 50 ml. Shake gently to mix well. Dexmedetomidine has been shown to be compatible when administered with the following intravenous fluids and drugs: Hartmanns 5% dextrose 0.9% sodium chloride H a n d l i n g Procedures Store at room temperature
DOSAGE: Dexmedetomidine HCl should be administered using a controlled infusion device. Dexmedetomidine dosing should be individualized and titrated to the desired clinical effect. It is generally initiated with:
A loading infusion of 1 mcg/kg over 10-20 minutes, (optional) followed by A maintenance infusion of 0.2-0.7 mcg/kg/hr.
The rate of the maintenance infusion should be adjusted to achieve the desired level of sedation. Note: doses of up to 1.4mcg/kg/hr are supported by clinical trial data.
Since dexmedetomidine clearance decreases with severity of hepatic impairment, dose reduction should be considered in patients with impaired hepatic function
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY: Dose as in normal renal function
DOSAGE IN PAEDIATRICS: There have been no clinical studies to establish the safety and efficacy of dexmedetomidine in paediatric patients below 18 years of age. Therefore, dexmedetomidine is not recommended for use in this population.
CLINICAL PHARMACOLOGY: Dexmedetomidine is a relatively selective alpha2-adrenoceptor agonist with sedative properties.
CONTRAINDICATIONS: 1. severebradycardia
WARNINGS Clinically significant episodes of bradycardia and sinus arrest have been associated with dexmedetomidine administration
Some patients receiving dexmedetomidine have been observed to be arousable and alert when stimulated. This alone should not be considered an evidence of lack of efficacy in the absence of other clinical signs and symptoms. Caution should be exercised when administering dexmedetomidine to patients with advanced heart block and/or severe ventricular dysfunction. Because dexmedetomidine decreases sympathetic nervous system activity, hypotension and/or bradycardia may be expected to be more pronounced in hypovolemic patients and in those with diabetes mellitus or chronic hypertension and in the elderly.
In situations where other vasodilators or negative chronotropic agents are administered, co-administration of dexmedetomidine could have an additive pharmacodynamic effect and should be administered with caution. Transient hypertension has been observed primarily during the loading dose in association with the initial peripheral vasoconstrictive effects of dexmedetomidine. Treatment of the transient hypertension has generally not been necessary, although reduction of the loading infusion rate may be desirable.
No tests in addition to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
IMPORTANT DRUG INTERACTIONS FOR THE ICU Co-administration of dexmedetomidine with anesthetics, sedatives, hypnotics, and opioids is likely to lead to an enhancement of effects.
Body as a Whole:
Hypotension, hypertension, bradycardia, tachycardia, atrial fibrillation
Hypoxia, dry mouth
Metabolic and endocrine system: