dexmedetomidine (Rx)

Brand and Other Names:Precedex
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 200mcg/2mL (100mcg/mL) single-dose glass vial
  • Requires further dilution before administering

ready-to-use injectable solution

  • 80mcg/20mL 0.9% NaCl (4mcg/mL)
  • 200mcg/50mL 0.9% NaCl (4mcg/mL)
  • 400mcg/100mL 0.9% NaCl (4mcg/mL)

ICU Sedation

Indicated for sedation of initially intubated and mechanically ventilated patients in ICU setting

Load: 1 mcg/kg IV over 10 minutes; loading dose may not be required for adults converted from other sedative therapy  

Maintenance 0.2-0.7 mcg/kg/hr continuous IV infusion; not to exceed 24 hr

Dexmedetomidine has been continuously infused in mechanically ventilated patients before, during, and after extubation; it is not necessary to discontinue dexmedetomidine before extubation

Procedural Sedation

Indicated for sedation of nonintubated patients before and/or during surgical and other procedures

Load: 1 mcg/kg IV over 10 minutes

Maintenance 0.6 mcg/kg/hr IV titrate to effect (usually 0.2-1 mcg/kg/hr)  

Awake fiberoptic Intubation

  • Load: 1 mcg/kg IV over 10 minutes  
  • Maintenance 0.7 mcg/kg/hr IV until endotracheal tube secured

Dosage Modifications

Dose reduction may be required if coadministered with other concomitant anesthetics, sedatives, hypnotics, or opioids

Consider dose reduction in patients with hepatic impairment or aged ≥65 yr; clearance decreases with increasing severity of hepatic impairment

Renal impairment: No dosage adjustment required

Safety and efficacy not established

ICU Sedation

Indicated for sedation of initially intubated and mechanically ventilated patients in ICU setting; not to exceed 24 hr

Consider dose reduction: Higher incidence of bradycardia and hypotension was observed following administration in patients aged >65 yr

Dexmedetomidine has been continuously infused in mechanically ventilated patients before, during, and after extubation; it is not necessary to discontinue dexmedetomidine before extubation

Procedural sedation

Indicated for sedation of nonintubated patients before and/or during surgical and other procedures

Reduced loading dose recommended: 0.5 mcg/kg IV over 10 minutes  

Maintenance: Consider reduced maintenance infusion

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Interactions

Interaction Checker

and dexmedetomidine

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            Contraindicated (1)

            • eliglustat

              dexmedetomidine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.

            Serious - Use Alternative (9)

            • calcium/magnesium/potassium/sodium oxybates

              dexmedetomidine, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • hydrocodone

              hydrocodone, dexmedetomidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • lonafarnib

              dexmedetomidine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

            • metoclopramide intranasal

              dexmedetomidine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • ponesimod

              ponesimod, dexmedetomidine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

            • sodium oxybate

              dexmedetomidine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • sufentanil SL

              sufentanil SL, dexmedetomidine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • valerian

              valerian and dexmedetomidine both increase sedation. Avoid or Use Alternate Drug.

            • vortioxetine

              dexmedetomidine increases levels of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Decrease vortioxetine dose by 50% when coadministered with strong CYP2D6 inhibitors.

            Monitor Closely (196)

            • albuterol

              dexmedetomidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              dexmedetomidine and alfentanil both increase sedation. Use Caution/Monitor.

            • alprazolam

              alprazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • amitriptyline

              dexmedetomidine and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • amoxapine

              dexmedetomidine and amoxapine both increase sedation. Use Caution/Monitor.

            • apomorphine

              dexmedetomidine and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              dexmedetomidine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aripiprazole

              dexmedetomidine and aripiprazole both increase sedation. Use Caution/Monitor.

            • armodafinil

              dexmedetomidine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • atogepant

              dexmedetomidine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • avapritinib

              dexmedetomidine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              dexmedetomidine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • azelastine

              azelastine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • baclofen

              dexmedetomidine and baclofen both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              dexmedetomidine and belladonna and opium both increase sedation. Use Caution/Monitor.

            • benazepril

              dexmedetomidine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • benperidol

              dexmedetomidine and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              dexmedetomidine increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brexpiprazole

              dexmedetomidine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer half of the usual brexpiprazole dose when coadministered with strong CYP2D6 inhibitors. If also administered with a strong/moderate CYP3A4 inhibitor, administer a quarter of brexpiprazole dose. NOTE: In MDD clinical trials, brexpiprazole dosage was not adjusted for strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine); thus, CYP considerations are already factored into general dosing recommendations and brexpiprazole may be administered without dosage adjustment in patients with MDD.

            • brompheniramine

              brompheniramine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • buprenorphine

              dexmedetomidine and buprenorphine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              dexmedetomidine and buprenorphine buccal both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              dexmedetomidine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

            • butabarbital

              butabarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • butorphanol

              dexmedetomidine and butorphanol both increase sedation. Use Caution/Monitor.

            • caffeine

              dexmedetomidine increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • captopril

              dexmedetomidine, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • carbinoxamine

              carbinoxamine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • carisoprodol

              dexmedetomidine and carisoprodol both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate, dexmedetomidine. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              dexmedetomidine and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              dexmedetomidine and chlorzoxazone both increase sedation. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • clemastine

              clemastine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • clomipramine

              dexmedetomidine and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • clozapine

              dexmedetomidine and clozapine both increase sedation. Use Caution/Monitor.

            • codeine

              dexmedetomidine and codeine both increase sedation. Use Caution/Monitor.

            • cyclizine

              cyclizine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              dexmedetomidine and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • dantrolene

              dexmedetomidine and dantrolene both increase sedation. Use Caution/Monitor.

            • desflurane

              desflurane and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • desipramine

              dexmedetomidine and desipramine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              dexmedetomidine increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmethylphenidate

              dexmedetomidine increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              dexmedetomidine increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextromoramide

              dexmedetomidine and dextromoramide both increase sedation. Use Caution/Monitor.

            • diamorphine

              dexmedetomidine and diamorphine both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • diazepam intranasal

              diazepam intranasal, dexmedetomidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

            • dichlorphenamide

              dichlorphenamide and dexmedetomidine both decrease serum potassium. Use Caution/Monitor.

            • diethylpropion

              dexmedetomidine increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difenoxin hcl

              dexmedetomidine and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              dexmedetomidine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • dipipanone

              dexmedetomidine and dipipanone both increase sedation. Use Caution/Monitor.

            • dobutamine

              dexmedetomidine increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              dexmedetomidine increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              dexmedetomidine increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              dexmedetomidine and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              dexmedetomidine and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              dexmedetomidine and doxylamine both increase sedation. Use Caution/Monitor.

            • droperidol

              dexmedetomidine and droperidol both increase sedation. Use Caution/Monitor.

            • eluxadoline

              dexmedetomidine increases levels of eluxadoline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2D6 inhibitors.

            • ephedrine

              dexmedetomidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              dexmedetomidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              dexmedetomidine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • estazolam

              estazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • ethanol

              dexmedetomidine and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • fenfluramine

              dexmedetomidine increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • finerenone

              dexmedetomidine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flibanserin

              dexmedetomidine and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

              dexmedetomidine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

            • fluphenazine

              dexmedetomidine and fluphenazine both increase sedation. Use Caution/Monitor.

            • flurazepam

              flurazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • formoterol

              dexmedetomidine increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • gotu kola

              gotu kola increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • haloperidol

              dexmedetomidine and haloperidol both increase sedation. Use Caution/Monitor.

            • hawthorn

              hawthorn increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • hops

              hops increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • hydromorphone

              dexmedetomidine and hydromorphone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • iloperidone

              dexmedetomidine and iloperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              dexmedetomidine and imipramine both increase sedation. Use Caution/Monitor.

            • isoproterenol

              dexmedetomidine increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ivacaftor

              dexmedetomidine increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

            • kava

              kava increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • ketamine

              ketamine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              dexmedetomidine and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lemborexant

              dexmedetomidine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

            • levalbuterol

              dexmedetomidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levorphanol

              dexmedetomidine and levorphanol both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              dexmedetomidine increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofepramine

              dexmedetomidine and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              dexmedetomidine and lofexidine both increase sedation. Use Caution/Monitor.

            • lomitapide

              dexmedetomidine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • loprazolam

              loprazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • loxapine

              dexmedetomidine and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              dexmedetomidine and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • lurasidone

              lurasidone and dexmedetomidine both increase pharmacodynamic synergism. Use Caution/Monitor. Potential for additive CNS effects

            • maprotiline

              dexmedetomidine and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              dexmedetomidine and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              dexmedetomidine and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              dexmedetomidine and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              dexmedetomidine and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              dexmedetomidine increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              dexmedetomidine and metaxalone both increase sedation. Use Caution/Monitor.

            • methadone

              dexmedetomidine and methadone both increase sedation. Use Caution/Monitor.

            • methamphetamine

              dexmedetomidine increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              dexmedetomidine and methocarbamol both increase sedation. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              dexmedetomidine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              midazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              dexmedetomidine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

              midazolam intranasal, dexmedetomidine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • midodrine

              dexmedetomidine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mirtazapine

              dexmedetomidine and mirtazapine both increase sedation. Use Caution/Monitor.

            • modafinil

              dexmedetomidine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              dexmedetomidine and morphine both increase sedation. Use Caution/Monitor.

            • motherwort

              dexmedetomidine and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              dexmedetomidine and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              dexmedetomidine and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              dexmedetomidine and nalbuphine both increase sedation. Use Caution/Monitor.

            • norepinephrine

              dexmedetomidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              dexmedetomidine and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              dexmedetomidine and olanzapine both increase sedation. Use Caution/Monitor.

            • oliceridine

              dexmedetomidine, oliceridine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • opium tincture

              dexmedetomidine and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              dexmedetomidine and orphenadrine both increase sedation. Use Caution/Monitor.

            • oxazepam

              oxazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • oxycodone

              dexmedetomidine and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              dexmedetomidine and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              dexmedetomidine and paliperidone both increase sedation. Use Caution/Monitor.

            • papaveretum

              dexmedetomidine and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              dexmedetomidine and papaverine both increase sedation. Use Caution/Monitor.

            • passion flower

              passion flower increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • pentazocine

              dexmedetomidine and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              pentobarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • perphenazine

              dexmedetomidine and perphenazine both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              dexmedetomidine increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • phentermine

              dexmedetomidine increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              dexmedetomidine increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              dexmedetomidine increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              dexmedetomidine and pholcodine both increase sedation. Use Caution/Monitor.

            • pimozide

              dexmedetomidine and pimozide both increase sedation. Use Caution/Monitor.

            • pirbuterol

              dexmedetomidine increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • primidone

              primidone and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              dexmedetomidine and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • propofol

              propofol and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              dexmedetomidine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              dexmedetomidine and protriptyline both increase sedation. Use Caution/Monitor.

            • quazepam

              quazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • quetiapine

              dexmedetomidine and quetiapine both increase sedation. Use Caution/Monitor.

            • ramelteon

              dexmedetomidine and ramelteon both increase sedation. Use Caution/Monitor.

            • risperidone

              dexmedetomidine and risperidone both increase sedation. Use Caution/Monitor.

            • salmeterol

              dexmedetomidine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scullcap

              dexmedetomidine and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • sevoflurane

              sevoflurane and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              dexmedetomidine and shepherd's purse both increase sedation. Use Caution/Monitor.

            • sufentanil

              dexmedetomidine and sufentanil both increase sedation. Use Caution/Monitor.

            • tamoxifen

              dexmedetomidine, tamoxifen. affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. CYP2D6 inhibition decreases metabolism of tamoxifen to hydroxytamoxifen, and N-desmethyl tamoxifen to endoxifen (active metabolites with 100-fold greater affinity for estrogen receptor); decreased endoxifen levels may result in poor clinical outcome.

            • tamsulosin

              dexmedetomidine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • tapentadol

              dexmedetomidine and tapentadol both increase sedation. Use Caution/Monitor.

            • tazemetostat

              dexmedetomidine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • temazepam

              temazepam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • terbutaline

              dexmedetomidine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              dexmedetomidine and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              dexmedetomidine and thiothixene both increase sedation. Use Caution/Monitor.

            • tinidazole

              dexmedetomidine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • topiramate

              dexmedetomidine and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              dexmedetomidine and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              dexmedetomidine and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • triclofos

              dexmedetomidine and triclofos both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              dexmedetomidine and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trimipramine

              dexmedetomidine and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              triprolidine and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • valbenazine

              dexmedetomidine will increase the level or effect of valbenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Consider reducing valbenazine dose based on tolerability if coadministered with a strong CYP2D6 inhibitor.

            • valerian

              valerian increases effects of dexmedetomidine by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • xylometazoline

              dexmedetomidine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              dexmedetomidine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              dexmedetomidine and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              dexmedetomidine and ziprasidone both increase sedation. Use Caution/Monitor.

            • zotepine

              dexmedetomidine and zotepine both increase sedation. Use Caution/Monitor.

            Minor (7)

            • ashwagandha

              ashwagandha increases effects of dexmedetomidine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

            • brimonidine

              brimonidine increases effects of dexmedetomidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • eucalyptus

              dexmedetomidine and eucalyptus both increase sedation. Minor/Significance Unknown.

            • nettle

              nettle increases effects of dexmedetomidine by pharmacodynamic synergism. Minor/Significance Unknown. (High dose nettle; theoretical interaction) May enhance CNS depression.

            • ruxolitinib

              dexmedetomidine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • sage

              dexmedetomidine and sage both increase sedation. Minor/Significance Unknown.

            • Siberian ginseng

              Siberian ginseng increases effects of dexmedetomidine by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

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            Adverse Effects

            >10%

            Hypotension (25-28%)

            Hypertension (12-16%)

            Nausea (9-11%)

            1-10%

            Bradycardia (5-7%)

            Pyrexia (4-5%)

            Atrial fibrillation (4%)

            Dry mouth (3-4%)

            Vomiting (3-4%)

            Hypoxia (2-4%)

            Hypovolemia (3%)

            Atelectasis (3%)

            Tachycardia (2-3%)

            Postprocedural hemorrhage (2-3%)

            Anemia (2-3%)

            Agitation (2%)

            Hyperthermia (2%)

            Pain (2%)

            Hyperglycemia (2%)

            Chills or rigors (2%)

            Hyperglycemia (2%)

            Oliguria (2%)

            Thirst (2%)

            Acidosis (1-2%)

            Pleural effusion (1-2%)

            Pulmonary edema (1%)

            Hypocalcemia (1%)

            Urine output decreased (1%)

            Sinus tachycardia (1%)

            <1%

            Ventricular tachycardia

            Wheezing

            Peripheral edema

            Postmarketing Reports

            Blood and lymphatic system disorders: Anemia

            Cardiac disorders: Arrhythmia, atrial fibrillation, atrioventricular block, bradycardia, cardiac arrest, cardiac disorder, extrasystoles, myocardial infarction, supraventricular tachycardia, tachycardia, ventricular arrhythmia, ventricular tachycardia

            Eye disorders: Photopsia, visual impairment

            Gastrointestinal disorders: Abdominal pain, diarrhea, nausea, vomiting

            General: Chills, hyperpyrexia, pain, pyrexia, thirst

            Investigations: AST/ALT increased, blood alkaline phosphatase increased, blood urea increased, EKG T wave inversion, GGT increased, QT prolonged

            Metabolism and nutrition disorders: Acidosis, hyperkalemia, hypoglycemia, hypovolemia, hypernatremia

            Nervous system disorders: Convulsion, dizziness, headache, neuralgia, neuritis, speech disorder

            Psychiatric disorders: Agitation, confusional state, delirium, hallucination, illusion

            Renal and urinary disorders: Oliguria, polyuria

            Respiratory, thoracic, and mediastinal disorders: Apnea, bronchospasm, dyspnea, hypercapnia, hypoventilation, hypoxia, pulmonary congestion, respiratory acidosis

            Skin and subcutaneous tissue disorders: Hyperhidrosis, pruritus, rash, urticaria

            Surgical and medical procedures: Light anesthesia

            Vascular disorders: Blood pressure fluctuation, hemorrhage, hypertension, hypotension

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            Warnings

            Contraindications

            None

            Cautions

            Continuously monitor patients while on therapy; therapy should be administered only by persons skilled in the management of patients in the intensive care or operating room setting

            Bradycardia and sinus arrest have occurred in young healthy volunteers with high vagal tone or with different routes of administration, including rapid IV bolus administration

            Caution 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 patients with hypovolemia, diabetes mellitus, or chronic hypertension, and in older patients

            Transient hypertension reported primarily during loading dose; consider reduction in loading infusion rate

            Patients can become aroused/alert with stimulation; this alone should not be considered as lack of efficacy

            Prolonged exposure to dexmedetomidine beyond 24 hours may be associated with tolerance and tachyphylaxis and a dose-related increase in adverse events (eg, ARDS, respiratory failure, agitation)

            Use with caution in hepatic impairment; consider dose reduction

            Hypotension and bradycardia may necessitate medical intervention; may be more pronounced in patients with hypovolemia, diabetes mellitus, or chronic hypertension, and in the elderly; use with caution in patients with advanced heart block or severe ventricular dysfunction

            Withdrawal symptoms after discontinuation reported when administered for longer than 6 hr; most common events reported include nausea, vomiting, and agitation

            Tachycardia and hypertension reported, requiring intervention 48 hr following study drug discontinuation; if tachycardia and/or hypertension occurs after discontinuation, supportive therapy is indicated

            Drug interaction overview

            • Caution if coadministered with other vasodilators or negative chronotropic agents owing to additive pharmacodynamic effects
            • Coadministration with anesthetics, sedatives, hypnotics, and opioids is likely to lead to an enhancement of pharmacodynamic effects
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            Pregnancy & Lactation

            Pregnancy

            There are no adequate and well-controlled studies of use in pregnant women

            In an in vitro human placenta study, placental transfer of dexmedetomidine occurred

            Animal studies

            • In pregnant rats, dexmedetomidine placental transfer observed when radiolabeled dexmedetomidine was administered SC
            • Thus, fetal exposure should be expected in humans; use during pregnancy only if potential benefits justify potential fetal risk

            Lactation

            Unknown if excreted in human milk

            Radio-labeled dexmedetomidine administered SC to lactating female rats was excreted in milk

            Because many drugs are excreted in human milk, caution should be exercised when administered to breastfeeding women

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Centrally acting alpha2-adrenoceptor agonist that has sedative and anesthetic properties possibly by activating G-proteins in the brainstem, which results in the inhibition of norepinephrine release

            Pharmacokinetics

            Half-life, elimination: 6 min; 2 hr (terminal)

            Peak plasma: 0.3-1.5 ng/mL

            Protein bound: 94%

            Vd: 118 L

            Metabolism: Liver, including glucuronidation and CYP2A6

            Metabolites: 3-hydroxy, 3-carboxy, 3-hydroxy N-methyl, 3-carboxy N-methyl, and N-methyl O-glucuronide dexmedetomidine

            Total body clearance: 39 L/hr

            Excretion: Urine (95%); feces (4%)

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            Administration

            IV Incompatibilities

            Y-site: amphotericin B, diazepam

            IV Compatibilities

            Solution: D5W, LR, 0.9% NaCl, mannitol 20%, MgSO4 100 mg/mL, KCl 0.3%

            Y-site (partial list): amiodarone, cefepime, cefoperazone, ceftriaxone, chlorpromazine, ciprofloxacin, clindamycin, digoxin, diphenhydramine, dobutamine, dopamine, epinephrine, fluconazole, furosemide, heparin, hydroxyzine, labetalol, lidocaine, linezolid, lorazepam, meperidine, metoclopramide, MgSO4, metronidazole, KCl, nitroglycerin, prochlorperazine, promethazine, NaHCO3, Na-nitroprusside, TMP-SMX, vancomycin, verapamil

            Not specified: atracurium, atropine, etomidate, fentanyl, glycopyrrolate, midazolam, mivacurium, morphine, pancuronium, phenylephrine, succinylcholine, thiopental, vecuronium

            IV Preparation

            200 mcg/2 mL (100 mcg/mL) vial

            • Must be diluted with 0.9% NaCl to achieve required concentration (4 mcg/mL) before
            • Preparation of solutions is the same, whether for the loading dose or maintenance infusion
            • Withdraw 2 mL of 100 mcg/mL dexmedetomidine and add to 48 mL of 0.9% NaCl to a total of 50 mL
            • Shake gently to mix well

            IV Administration

            Use controlled infusion device; use components made with synthetic or coated natural rubber gaskets

            Infuse loading dose over 10 min

            Maintenance dose: Administer by IV continuous infusion at recommended rate; individualized infusion rte and adjust rate to desired clinical response

            Storage

            Controlled room temperature of 25ºC (77ºF); excursions allowed from 15-30ºC (59-86ºF)

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Precedex intravenous
            -
            100 mcg/mL vial
            dexmedetomidine intravenous
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            100 mcg/mL vial
            dexmedetomidine intravenous
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            100 mcg/mL vial
            dexmedetomidine intravenous
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            100 mcg/mL vial
            dexmedetomidine intravenous
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            100 mcg/mL vial
            dexmedetomidine intravenous
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            100 mcg/mL vial
            dexmedetomidine intravenous
            -
            100 mcg/mL vial
            dexmedetomidine intravenous
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            100 mcg/mL vial
            dexmedetomidine intravenous
            -
            100 mcg/mL vial
            dexmedetomidine intravenous
            -
            100 mcg/mL vial
            dexmedetomidine intravenous
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            100 mcg/mL vial
            dexmedetomidine intravenous
            -
            100 mcg/mL vial
            dexmedetomidine intravenous
            -
            100 mcg/mL vial
            dexmedetomidine intravenous
            -
            100 mcg/mL vial
            dexmedetomidine intravenous
            -
            100 mcg/mL vial
            dexmedetomidine intravenous
            -
            100 mcg/mL vial
            dexmedetomidine intravenous
            -
            100 mcg/mL vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            dexmedetomidine intravenous

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.