dexmedetomidine hydrochloride: clinical use

Prescribing considerations

• Hospital use by clinicians skilled in intensive-care or anaesthetic management.
• Produces a rousable sedation profile and is unsuitable when uninterrupted deep sedation is required.
• Not an induction agent for general anaesthesia and does not suppress underlying seizure activity.
• Exercise particular caution with cardiovascular instability, pre-existing bradycardia, hypovolaemia, ventricular dysfunction, older age, hepatic impairment and severe neurological disease.
• Abrupt discontinuation after prolonged use may be followed by agitation and hypertension.

Contraindications and cautions

• Hypersensitivity to dexmedetomidine or an excipient.
• Second- or third-degree heart block unless paced.
• Uncontrolled hypotension.
• Acute cerebrovascular conditions.

Monitoring

• Continuous cardiac and blood-pressure monitoring during infusion.
• Monitor respiration in non-intubated patients and ensure oxygen and airway support are available.
• Assess sedation depth and adequacy because patients may remain rousable.
• Investigate sustained unexplained fever.
• If polyuria develops, assess serum sodium and urine osmolality for possible diabetes insipidus.

Clinical pharmacology

A selective alpha-2 receptor agonist producing central sympatholysis by reducing noradrenaline release. Sedation is mediated mainly through the locus coeruleus. It is extensively metabolised in the liver, with negligible activity from the principal metabolites; hepatic impairment reduces clearance and may prolong effects.

Formulation and product differences

• The selected product is a clear, colourless concentrate for intravenous infusion supplied in single-patient ampoules or vials.
• It requires dilution with a compatible infusion fluid and administration through a controlled infusion device.
• Use synthetic or coated natural-rubber components where possible because adsorption to some natural rubber may occur.
• Do not mix with medicines or fluids unless compatibility is established.

Solution for infusion

Route: Intravenous

Strengths: 4 micrograms/mL, 100 micrograms/mL