What is the starting infusion rate for Dexmedetomidine (Precedex)?

From the Guidelines

Dexmedetomidine should be started at an infusion rate of 0.2-0.7 μg/kg/hr, with an optional loading dose of 1 μg/kg given over 10 minutes, as this dosing regimen has been shown to provide effective sedation while minimizing the risk of adverse effects such as hypotension and bradycardia 1.

Key Considerations

• The infusion can be titrated every 5-10 minutes to achieve the desired level of sedation, with a maximum recommended rate of 1.5 μg/kg/hr as tolerated 1.
• No bolus is required when using dexmedetomidine for procedural sedation or ICU sedation, though some clinicians prefer to use the loading dose in certain situations.
• The medication should be administered using an infusion pump for accuracy, and patients should be monitored for potential side effects including hypotension and bradycardia.
• Dexmedetomidine works by stimulating alpha-2 adrenergic receptors in the central nervous system, providing sedation without significant respiratory depression, which makes it particularly useful in mechanically ventilated patients or those requiring conscious sedation 1.

Important Safety Information

• Dexmedetomidine can cause a loss of oropharyngeal muscle tone, which can lead to airway obstruction in nonintubated patients, so continuous respiratory monitoring for both hypoventilation and hypoxemia in these patients is indicated 1.
• The medication has a relatively short half-life of approximately 2 hours, allowing for quick recovery after discontinuation of the infusion 1.

From the Research

Dexmedetomidine Starting Infusion Rate

• The starting infusion rate of dexmedetomidine can vary depending on the patient population and the desired level of sedation 2.
• A study in neurocritical care patients found that the mean initial dexmedetomidine infusion rate was 0.67 +/- 0.2 mcg/kg/h 2.
• Another study in critically ill patients found that a loading dose of 0.5 µg/kg/h was effective for rapid sedation, while a maintenance dose of 0.4 µg/kg/h provided an ideal sedative effect 3.
• In pediatric patients with heart disease, dexmedetomidine was started at a dose of 0.5-1.0 µg/kg/h and titrated to effect 4.
• The pharmacokinetics of dexmedetomidine have been studied in critically ill patients, and the results suggest linear pharmacokinetics up to a dose of 2.5 µg/kg/h 5.

Factors Influencing Starting Infusion Rate

• Patient population: The starting infusion rate may vary depending on the patient population, such as neurocritical care patients, critically ill patients, or pediatric patients with heart disease 2, 3, 4.
• Desired level of sedation: The starting infusion rate may be adjusted based on the desired level of sedation, with higher doses used for more rapid sedation 3.
• Hemodynamic parameters: The starting infusion rate may be influenced by hemodynamic parameters, such as heart rate and blood pressure, with lower doses used in patients with hemodynamic instability 2, 3.

Safety and Efficacy

• Dexmedetomidine has been shown to be safe and effective in various patient populations, including neurocritical care patients, critically ill patients, and pediatric patients with heart disease 2, 3, 4.
• The most common adverse events associated with dexmedetomidine are hypotension, bradycardia, and dry mouth 6.
• Dexmedetomidine has been shown to decrease the need for opioids and benzodiazepines, and to reduce the risk of delirium in critically ill patients 6, 4.