Recommended Diluent for Dexmedetomidine
The recommended diluent for dexmedetomidine is 0.9% sodium chloride (normal saline). 1
Formulation and Preparation
- Dexmedetomidine is available as 200-mcg/2-mL vials that require dilution prior to administration 1
- When diluted in 0.9% sodium chloride, dexmedetomidine admixtures remain stable for 14 days under refrigeration and 48 hours at room temperature 1
- The stability has been confirmed in both polyvinyl chloride (PVC) bags and non-PVC bags 1
Administration Considerations
- For ICU sedation, the American College of Critical Care Medicine recommends an initial loading dose of 1 μg/kg over 10 minutes, followed by a maintenance infusion of 0.2-0.7 μg/kg/hour 2
- The maintenance infusion may be increased up to 1.5 μg/kg/hour as tolerated 2
- Loading doses should be avoided in hemodynamically unstable patients due to the risk of hypotension 2
Pharmacological Properties
- Dexmedetomidine is a selective α-2 adrenoreceptor agonist with sedative, analgesic, and sympatholytic properties 2
- It has a relatively short elimination half-life of 1.8-3.1 hours in patients with normal liver function 2
- The drug produces minimal respiratory depression compared to other sedatives, making it suitable for non-intubated patients 3
Monitoring Requirements
- Continuous hemodynamic monitoring is essential during dexmedetomidine administration due to the risk of hypotension (10-20% of patients) and bradycardia 3, 2
- Regular sedation assessment should be performed as the drug produces a unique pattern of sedation where patients remain easily arousable 3
- In non-intubated patients, continuous respiratory monitoring for hypoventilation and hypoxemia is recommended 3
Special Considerations
- Patients with severe hepatic dysfunction have impaired dexmedetomidine clearance and may require lower doses 3, 2
- Initial IV loading doses can cause a biphasic cardiovascular response - transient hypertension followed by hypotension within 5-10 minutes 3
- The pH of dexmedetomidine solutions typically remains between 4.7 and 5.8 during the study period 1