turn away [18:65 years of age. 1 Hypotension and/or bradycardia may be more pronounced. 1 Monitor renal function. 1 Renal Impairment Use with caution. 1 (See Renal Impairment under Dosage and Administration.) Hepatic Impairment Use with caution. 1 (See Dosage and Administration.) Common Adverse Effects Hypotension, 1 8 hypertension, 1 nausea, 1 bradycardia, 1 8 fever, 1 16 vomiting, 1 16 hypoxia, 1 tachycardia, 16 anemia. 1 Interactions for Dexmedetomidine Hydrochloride Metabolized by CYP isoenzymes, principally CYP2A6. 1 However, no evidence of clinically important CYP-mediated drug interactions in vitro. 1 Agents with Negative Chronotropic Effects Potential pharmacodynamic interaction (additive pharmacodynamic effects). 16 Use with caution. 16 Protein-bound Drugs Pharmacokinetic interaction unlikely. 1 Specific Drugs Drug Interaction Comments Anesthetics Additive pharmacologic effects 1 8 May require reduction in anesthetic dosage 1 8 Digoxin Negligible change in dexmedetomidine protein binding in vitro; negligible displacement of digoxin from protein binding sites in vitro 1 Fentanyl Negligible change in dexmedetomidine protein binding in vitro 1 Ibuprofen Negligible displacement of ibuprofen from protein binding sites in vitro 1 Ketorolac Negligible change in dexmedetomidine protein binding in vitro 1 Lidocaine Negligible change in dexmedetomidine protein binding in vitro 1 Neuromuscular blocking agents Increased plasma rocuronium concentrations 1 12 No clinically important effect on neuromuscular blockade 1 12 Opiate agonists Additive pharmacologic effects 1 8 May require reduction in opiate agonist dosage 1 8 Phenytoin Negligible displacement of phenytoin from protein binding sites in vitro 1 Propranolol Negligible displacement of propranolol from protein binding sites in vitro 1 Sedatives/hypnotics Additive pharmacologic effects 1 8 May require reduction in sedative/hypnotic dosage 1 8 Theophylline Negligible change in dexmedetomidine protein binding in vitro; negligible displacement of theophylline from protein binding sites in vitro 1 Vasodilators Additive pharmacologic effects 16 Use with caution 16 Warfarin Negligible displacement of warfarin from protein binding sites in vitro 1 Dexmedetomidine Hydrochloride Pharmacokinetics Distribution Extent Rapidly distributed. 16 Crosses the placenta and is distributed into milk when administered sub-Q to rats. 1 Plasma Protein Binding Approximately 94%. 16 Elimination Metabolism Undergoes almost complete biotransformation by direct glucuronidation, aliphatic hydroxylation by CYP2A6, and N -methylation. 1 15 Elimination Route Excreted in urine (95%) and feces (4%). 16 Half-life Terminal elimination half-life is approximately 2 hours. 2 3 6 Special Populations In patients with mild, moderate, or severe hepatic impairment, mean clearance values were 74, 64, or 53%, respectively, of those in healthy subjects. 16 Pharmacokinetics of dexmedetomidine metabolites in patients with renal impairment not determined to date; potential for accumulation with long-term infusion. 16 Stability Storage Parenteral Injection Concentrate 25 C (may be exposed to temperatures ranging from 15 30 C). 1 Compatibility For information on systemic interactions resulting from concomitant use, see Interactions. Should not be infused through the same IV line with blood or plasma. 1 Parenteral Solution Compatibility Compatible 1 Dextrose 5% Lactated Ringer s Mannitol 20% Sodium chloride 0.9% Drug Compatibility Y-Site Injection Compatibility Compatible 1 HID Alfentanil HCl Amikacin sulfate Aminophylline Amiodarone HCl Ampicillin sodium Ampicillin sodium-sulbactam sodium Atracurium besylate Atropine sulfate Azithromycin Azetreonam Bretylium tosylate Bumetanide Butorphanol tartrate Calcium gluconate Cefazolin sodium Cefepime HCl Cefotaxime sodium Cefoxitin sodium Ceftizoxime sodium Ceftriaxone sodium Cefuroxime sodium Chlorpromazine HCl Cimetidine HCl Ciprofloxacin Clindamycin phosphate Co-trimoxazole Dexamethasone sodium phosphate Digoxin Diltiazem HCl Diphenhydramine HCl Dobutamine HCl Dolasetron mesylate Dopamine HCl Doxycycline hyclate Droperidol Enalaprilat Ephedrine sulfate Epinephrine HCl Erythromycin lactobionate Esmolol HCl Etomidate Famotidine Fentanyl citrate Fenoldopam mesylate Fluconazole Furosemide Gentamicin sulfate Glycopyrrolate Granisetron HCl Haloperidol lactate Heparin sodium Hydromorphone HCl Hydroxyzine HCl Inamrinone lactate Isoproterenol HCl Ketorolac tromethamine Labetalol HCl Levofloxacin Lidocaine HCl Linezolid Lorazepam Magnesium sulfate Meperidine HCl Methylprednisolone sodium succinate Metoclopramide HCl Metronidazole Midazolam HCl Milrinone lactate Mivacurium chloride Morphine sulfate Nalbuphine HCl Nitroglycerin Norepinephrine bitartrate Ofloxacin Ondansetron HCl Pancuronium bromide Phenylephrine HCl Piperacillin sodium-tazobactam sodium Potassium chloride Procainamide HCl Prochlorperazine edisylate Promethazine HCl Propofol Ranitidine HCl Remifentanil HCl Rocuronium bromide Sodium bicarbonate Sodium nitroprusside Succinylcholine chloride Sufentanil citrate Theophylline Thiopental sodium Ticarcillin disodium-clavulanate potassium Tobramycin sulfate Vancomycin Vecuronium bromide Verapamil Incompatible Amphotericin B Diazepam Actions Dose-related sedative, anxiolytic, analgesic, and anesthetic-sparing effects; 2 3 5 6 8 13 does not appear to reduce dosage requirements of skeletal muscle relaxants. 3 12 Helps maintain intraoperative hemodynamic stability by blunting sympathetic response to surgery. 2 3 5 6 8 13 Does not cause respiratory depression in healthy individuals when given by IV infusion in recommended dosages. 1 Compared with clonidine, dexmedetomidine has a shorter half-life 2 3 5 (about 2 versus 8 12 hours) 2 3 6 and greater α 2 -selectivity, with potential for reduced incidence of undesirable α 1 -adrenergic effects (e.g., hypotension, bradycardia). 3 Exhibits α 2 -selectivity when given by slow IV infusion in low to moderate doses (10 300 mcg/kg); selectivity diminishes at 12 high doses (e.g., 1000 mcg/kg) or with rapid IV administration. 1 Advice to Patients Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant diseases. 1 Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. 1 Importance of informing patients of other important precautionary information. (See Cautions.) 1 Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Dexmedetomidine Hydrochloride Routes Dosage Forms Strengths Brand Names Manufacturer Parenteral For injection concentrate, for IV infusion 100 mcg (of dexmedetomidine) per mL Precedex (preservative-free) Abbott AHFS DI Essentials. Copyright 2017, Selected Revisions August 1, 2007. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. References 1. Abbott Laboratories. Precedex (dexmedetomidine) injection prescribing information. North Chicago, IL; 2000 Feb. 2. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia . 1999; 54:146-65. [PubMed 10215710] 3. Kamibayashi T, Harasawa K, Maze M. Alpha-2 adrenergic agonists. Can J Anaesth . 1997; 44:R13-R18. [PubMed 9196836] 4. Peden CJ, Prys-Roberts C. Dexmedetomidine a powerful new adjunct to anaesthesia? Br J Anaesth . 1992; 68:123-5. Editorial. 5. Shipton EA. Alpha-adrenergic agonists in anaesthesia and analgesia. S Afr Med J . 1991; 79:578-80. [PubMed 1674173] 6. Jalonen J, Hynynen M, Kuitunen A et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology . 1997; 86:331-45. [PubMed 9054252] 7. Aho M, Lehtinen A-M, Erkola O et al. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology . 1991; 74:997-1002. [PubMed 1675042] 8. Aho MS, Erkola OA, Scheinin H et al. Effect of intravenously administered dexmedetomidine on pain after laparoscopic tubal ligation. Anesth Analg . 1991; 73:112-8. [PubMed 1854025] 9. Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability. Anaesthesia . 1997; 52:736-44. [PubMed 9291757] 10. Talke P, Li J, Jain U et al. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. Anesthesiology . 1995; 82:620-33. [PubMed 7879930] 11. Jaakola M-L, Ali-Melkkila T, Kanto J et al. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth . 1992; 68:570-5. [PubMed 1351736] 12. Talke PO, Caldwell JE, Richardson CA et al. The effects of dexmedetomidine on neuromuscular blockade in human volunteers. Anesth Analg . 1999; 88:633-9. [PubMed 10072019] 13. Khan ZP, Munday IT, Jones RM et al. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1. Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth . 1999; 83:372-80. [PubMed 10655905] 14. Aho M, Erkola O, Kallio A et al. Dexmedetomidine infusion for maintenance of anesthesia in patients undergoing abdominal hysterectomy. Anesth Analg . 1992; 75:940-6. [PubMed 1359809] 15. Abbott, Abbott Park, IL: Personal communication. 16. Abbott Laboratories. Precedex (dexmedetomidine) injection prescribing information. North Chicago, IL; 2001 Feb. HID. Trissel LA. Handbook on injectable drugs. 14th ed; Bethesda, MD: American Society of Health-System Pharmacists; 2007:489-95. Next Interactions Print this page Add to My Med List More about dexmedetomidine Side Effects During Pregnancy Dosage Information Drug Interactions Support Group Pricing & Coupons En Español 0 Reviews Add your own review/rating Drug class: miscellaneous anxiolytics, sedatives and hypnotics Consumer resources Dexmedetomidine Professional resources Dexmedetomidine Hydrochloride Injection (FDA) Dexmedetomidine hydrochloride Injection, Concentrate (FDA) Dexmedetomidine (Wolters Kluwer) Other brands: Precedex Related treatment guides Sedation]} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Manufacturers Akorn, Inc. Mylan Pharmaceuticals Inc. Sandoz Inc. Teva Pharmaceuticals USA, Inc. Sun Pharmaceutical Industries Inc. 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