Precedex
Generic Name
Dexmedetomidine
Manufacturer
Various (e.g., Pfizer originally for Precedex)
Country
Global, initially USA
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Description
Overview of the medicine
Dexmedetomidine is a potent and highly selective alpha-2 adrenergic agonist used for sedation in adult and pediatric patients in intensive care settings and for procedural sedation.
Uses & Indications
Dosage
Adults
ICU Sedation: Initial loading infusion of 1 mcg/kg over 10 minutes, followed by a maintenance infusion of 0.2-1.5 mcg/kg/hour. Procedural Sedation: Initial loading infusion of 1 mcg/kg over 10 minutes, followed by a maintenance infusion of 0.2-1 mcg/kg/hour.
Elderly
Consider a dose reduction for elderly patients, especially those with impaired renal or hepatic function.
Renal_impairment
Dose reduction may be considered, especially with prolonged infusions or in patients with severe renal impairment.
Hepatic_impairment
Dose reduction is recommended in patients with hepatic impairment due to reduced clearance.
How to Take
Administered by continuous intravenous infusion using an infusion pump. Must be diluted before administration.
Mechanism of Action
It works by selectively stimulating alpha-2 adrenergic receptors in the brain, primarily in the locus coeruleus, leading to sedation, anxiolysis, and analgesia without significant respiratory depression.
Pharmacokinetics
Onset
Sedative effects usually observed within 5-10 minutes of beginning infusion.
Excretion
Primarily excreted in urine (95%) and feces (4%).
Half life
Terminal elimination half-life is approximately 2-3 hours.
Absorption
Rapid absorption after intravenous infusion with 100% bioavailability.
Metabolism
Extensively metabolized in the liver via direct N-glucuronidation and cytochrome P450-mediated hydroxylation.
Side Effects
Contraindications
- Known hypersensitivity to dexmedetomidine or any component of the formulation.
- Severe bradycardia or heart block (relative contraindication, use with extreme caution).
Drug Interactions
Vasodilators, beta-blockers
May enhance hypotensive and bradycardic effects.
Anesthetics, sedatives, hypnotics, opioids
May potentiate the sedative and hypotensive effects of dexmedetomidine.
Storage
Store at 20°C to 25°C (68°F to 77°F). Protect from light. Do not freeze.
Overdose
Symptoms include bradycardia, hypotension, excessive sedation, and heart block. Management is primarily supportive, focusing on maintaining cardiovascular stability.
Pregnancy & Lactation
Pregnancy Category C. Should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Excreted in human milk, so caution is advised during breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years, refer to manufacturer's specific instructions.
Availability
Hospitals, critical care units, pharmacies (with hospital prescription)
Approval Status
FDA approved
Patent Status
Generic available
Clinical Trials
Extensive clinical trials have demonstrated its efficacy and safety for ICU sedation and procedural sedation in various patient populations.
Lab Monitoring
- Heart rate
- Blood pressure
- Oxygen saturation
- Sedation level (e.g., RASS scale)
- ECG monitoring
Doctor Notes
- Close hemodynamic monitoring is crucial due to potential for bradycardia and hypotension.
- Use with caution in patients with pre-existing heart block, severe ventricular dysfunction, or hypovolemia.
- Dose adjustment required in hepatic impairment.
Patient Guidelines
- Dexmedetomidine is administered in a supervised medical setting. Patients should report any discomfort or adverse effects to the healthcare team.
- Do not attempt to drive or operate machinery for at least 24 hours after administration or until full recovery of mental alertness.
- Avoid alcohol and other CNS depressants after receiving this medication.
Missed Dose Advice
Not applicable as this medication is administered in a controlled hospital setting by healthcare professionals.
Driving Precautions
Patients should not drive or operate hazardous machinery for at least 24 hours after receiving dexmedetomidine due to its sedative effects.
Lifestyle Advice
- This medication is used for acute sedation and does not typically require long-term lifestyle adjustments. Follow post-procedure instructions carefully.
- Ensure adequate rest and hydration as advised by your doctor.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.