What is Presedex (dexmedetomidine)?

From the Guidelines

Precedex (dexmedetomidine) is recommended as a first-line agent for sedation in critically ill, mechanically ventilated adults, due to its ability to provide sedation while allowing patients to remain arousable and cooperative, with minimal respiratory depression compared to other sedatives, as shown in a large randomized controlled trial of 432 patients with sepsis 1. The typical dosage for ICU sedation is 0.2-0.7 mcg/kg/hr as a continuous infusion, often following an optional loading dose of 1 mcg/kg over 10 minutes. For procedural sedation, doses range from 0.2-1 mcg/kg/hr, with or without an initial loading dose. Some key points to consider when using Precedex include:

• It has analgesic and anxiolytic properties, potentially reducing the need for opioids
• Common side effects include hypotension and bradycardia due to its sympatholytic effects
• It should be used cautiously in patients with cardiovascular disease, and dose adjustments may be necessary for hepatic impairment
• The medication's half-life is approximately 2 hours, with effects typically resolving within 30-60 minutes after discontinuation of the infusion, as described in a study on the clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit 1. Additionally, guidelines suggest using either propofol or dexmedetomidine over benzodiazepines for sedation in critically ill, mechanically ventilated adults, due to the improved clinical outcomes associated with lighter levels of sedation 1. It's also worth noting that dexmedetomidine has been shown to be effective in reducing delirium in ICU patients, and is recommended as a sedation agent for patients at risk of delirium 1. Overall, Precedex is a valuable option for sedation in critically ill patients, offering a unique combination of sedative, analgesic, and anxiolytic effects with minimal respiratory depression.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Dexmedetomidine is a potent non-narcotic alpha2-adrenoceptor agonist which produces sedation and analgesia. The answer to the question about Presedex (another name for Dexmedetomidine) is that it is a potent non-narcotic alpha2-adrenoceptor agonist which produces sedation and analgesia.

• Key effects of dexmedetomidine include:
  • Sedation
  • Analgesia
  • Decrease in heart rate
  • Decrease in respiratory rate
  • Decrease in body temperature
  • Increase in blood glucose levels
  • Increase in production of urine
• Important notes:
  • The depth and duration of sedation are dose dependent.
  • Cardiac arrhythmias may occur, including second degree atrioventricular blocks.
  • Vomiting has been associated with alpha2-adrenergic agonist central stimulation of the brain in cats. 2

From the Research

Overview of Presedex (Dexmedetomidine)

• Presedex, also known as dexmedetomidine, is a selective α(2)-adrenergic receptor agonist used for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation in non-intubated patients 3.
• It is indicated in the US for the sedation of mechanically ventilated adult patients in an intensive care setting and in non-intubated adult patients prior to and/or during surgical and other procedures 3.

Efficacy of Presedex

• Dexmedetomidine has been shown to be effective in reducing the need for rescue sedation with intravenous propofol or intravenous midazolam and reducing opioid requirements in mechanically ventilated patients in an intensive care setting 3, 4.
• Patients receiving dexmedetomidine are calm and easy to arouse and manage, and it is associated with a lower rate of postoperative delirium than midazolam or propofol 3, 5.
• Dexmedetomidine is also effective for procedural sedation in non-intubated patients, including those undergoing awake fibre-optic intubation or a variety of diagnostic or surgical procedures requiring monitored anaesthesia care 3, 6.

Safety and Tolerability of Presedex

• Dexmedetomidine is generally well tolerated, but it can cause hypotension and bradycardia, which usually resolve without intervention 3, 4.
• It is not associated with respiratory depression, making it a safe option for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation in non-intubated patients 3, 4.
• The use of dexmedetomidine in septic patients without shock has been studied, and it was found to have a similar frequency of negative hemodynamic events compared to propofol, although the degree of hypotension was greater with propofol 7.

Clinical Use of Presedex

• Dexmedetomidine can be used for short-term (<24 hours) primary sedation in mechanically ventilated adult patients in an intensive care setting and in non-intubated adult patients prior to and/or during surgical and other procedures 3.
• It can also be used for longer-term sedation in an intensive care setting, and has been shown to be noninferior to midazolam and propofol in terms of time spent at the target sedation range 5.
• The loading dose and infusion dose of dexmedetomidine can vary, and it can be administered in conjunction with local anesthesia and/or other sedatives 6.