What is the use of Precedex (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 without significant respiratory depression and its opioid-sparing effects, as supported by the most recent and highest quality study 1.

Key Points

• The typical dosing of Precedex is 0.2-0.7 mcg/kg/hr as a continuous infusion, often preceded by a loading dose of 1 mcg/kg over 10 minutes in some situations.
• Precedex provides sedation without significant respiratory depression, making it valuable for mechanically ventilated patients or those requiring conscious sedation.
• It has analgesic properties and can reduce opioid requirements, as shown in studies comparing dexmedetomidine to other sedatives 1.
• Common side effects include hypotension and bradycardia, so continuous monitoring of vital signs is essential during administration, as noted in several studies 1.
• The medication works by decreasing central nervous system sympathetic outflow, producing sedation similar to natural sleep.
• Precedex should be used cautiously in patients with advanced heart block, severe ventricular dysfunction, or hypovolemia, as recommended in guidelines 1.
• Dose adjustments may be necessary for patients with hepatic impairment as it is primarily metabolized by the liver, as indicated in the study by 1.

Benefits and Risks

• Benefits: sedation without significant respiratory depression, opioid-sparing effects, and ability to provide sedation similar to natural sleep.
• Risks: hypotension, bradycardia, and potential for airway obstruction in nonintubated patients, as noted in the study by 1.

Clinical Use

• Precedex is used primarily for sedation in intensive care settings and during procedures.
• It is recommended to use Precedex as a first-line agent for sedation in critically ill, mechanically ventilated adults, as supported by the most recent and highest quality study 1.
• Continuous monitoring of vital signs is essential during administration, and dose adjustments may be necessary for patients with hepatic impairment.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Dexmedetomidine is a potent non-narcotic alpha2-adrenoceptor agonist which produces sedation and analgesia. The magnitude and duration of the decrease in body temperature is dose dependent Dexmedetomidine causes depression of gastrointestinal motility due to decrease in smooth muscle activity, increases in blood glucose levels due to inhibition of insulin release, and increases in production of urine. Spontaneous muscle contractions (twitching) can be expected in some dogs sedated with dexmedetomidine Vomiting in cats has been associated with alpha2-adrenergic agonist central stimulation of the brain

Precedex (Dexmedetomidine) is a sedative and analgesic medication.

• It produces sedation and analgesia in a dose-dependent manner.
• The medication can cause decreases in body temperature, depression of gastrointestinal motility, increases in blood glucose levels, and increases in urine production.
• Adverse effects may include vomiting, bradycardia, tachycardia, and arrhythmias.
• The medication can be used for sedation and analgesia in dogs and cats undergoing various procedures. 2

From the Research

Overview of Precedex (Dexmedetomidine)

• Precedex, also known as dexmedetomidine, is a sedative used in intensive care units (ICUs) and for procedural sedation 3, 4, 5.
• It is an α(2)-receptor agonist that provides effective sedation without significant respiratory depression 4, 5.

Efficacy and Safety

• Studies have shown that dexmedetomidine is effective in achieving sedation goals in ICU patients and reducing the need for rescue sedation with other agents 3, 5.
• However, high doses of dexmedetomidine may not enhance sedation efficacy and may be associated with a higher incidence of undersedation 3.
• Dexmedetomidine is generally well-tolerated, but it can cause hypotension and bradycardia, which usually resolve without intervention 4, 5, 6.

Clinical Use

• Dexmedetomidine can be used as a primary sedative in mechanically ventilated patients in ICUs and for procedural sedation in non-intubated patients 5.
• It may reduce the duration of mechanical ventilation and delirium among patients in ICUs 6.
• Prolonged infusions of dexmedetomidine have been shown to be safe and effective in critically ill patients, without significant rebound effects after discontinuation 7.

Comparison to Other Sedatives

• Dexmedetomidine has been compared to other sedatives, such as propofol and midazolam, and has been shown to have similar efficacy with a reduced incidence of delirium and coma 5, 6.
• However, dexmedetomidine may require supplemental sedatives to achieve the prescribed level of sedation in some patients 6.