What is a sample order for dexmedetomidine (Precedex)?

From the Guidelines

A typical dexmedetomidine order should be: "Dexmedetomidine 1 mcg/kg loading dose over 10 minutes, followed by a maintenance infusion of 0.2-0.7 mcg/kg/hour, titrated to desired level of sedation". This medication is commonly used for procedural sedation or in intensive care settings for short-term sedation of intubated patients 1. The loading dose can be omitted if hemodynamic concerns exist, starting directly with the maintenance infusion, as it can cause hypotension or hypertension 1. Dexmedetomidine should be administered via a controlled infusion device, and the patient requires continuous monitoring of vital signs including heart rate, blood pressure, and oxygen saturation during administration.

Key Considerations

• Dose adjustments may be needed for patients with hepatic impairment, as the drug is primarily metabolized by the liver 1.
• Dexmedetomidine works as a selective alpha-2 adrenergic agonist, providing sedation, anxiolysis, and some analgesia without significant respiratory depression, which is its main advantage over other sedatives 1.
• Common side effects to monitor for include hypotension and bradycardia, especially during the loading dose or with rapid titration 1.

Administration Details

• The onset of sedation occurs within 15 minutes and peak sedation occurs within 1 hour of starting an IV infusion of dexmedetomidine 1.
• In patients with normal liver function, the elimination half-life is approximately 3 hours 1.
• Patients with severe hepatic dysfunction have impaired dexmedetomidine clearance, can experience prolonged emergence, and may require lower dexmedetomidine doses 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dogs - 0. 1 Sedation and Analgesia: 500 mcg/m2 intramuscularly (IM) or 375 mcg/m2 intravenously (IV). Table 1: CANINE SEDATION/ANALGESIA DOSE TABLE: Intravenous (IV) and intramuscular (IM) dosing on the basis of body weight. Table 2: CANINE PREANESTHESIA DOSE TABLE: Intramuscular (IM) dosing on the basis of body weight. Cats - 0. 1 Sedation, Analgesia and Preanesthesia: 40 mcg/kg intramuscularly (IM). Table 3: FELINE DOSE TABLE: Intramuscular (IM) dosing on the basis of body weight in cats.

To write a dexmedetomidine sample order, consider the following key points:

• Species: Determine if the patient is a dog or a cat.
• Indication: Decide if the medication is for sedation, analgesia, or preanesthesia.
• Weight: Accurately weigh the patient to determine the correct dosage.
• Dosage: Use the provided tables to calculate the correct dose based on the patient's weight and the chosen route of administration (IV or IM).
• Concentration: Ensure the correct concentration of DEXDOMITOR is used, and adjust the dose accordingly.
• Fasting: Recommend fasting the patient for 12 hours before treatment.
• Eye care: Apply an eye lubricant to cats to prevent corneal desiccation.
• Monitoring: Allow the animal to rest quietly for 15 minutes after injection and monitor for sedation and analgesia, which occur within 5 to 15 minutes, with peak effects at 30 minutes 2.

From the Research

Dexmedetomidine Sample Order

• The recommended administration of dexmedetomidine is as a loading dose infused over 10 min 3.
• A study found that a rapid 5 s bolus of dexmedetomidine can be given to healthy children during total intravenous anesthesia (TIVA) without causing significant hemodynamic effects, with an ED50 of 0.49 mcg·kg(-1) 3.
• Dexmedetomidine is generally well tolerated and is not associated with respiratory depression, but it can cause hypotension and bradycardia, which usually resolve without intervention 4, 5.
• The use of dexmedetomidine in ICU patients has been shown to reduce the duration of mechanical ventilation and improve patient comfort, but it can also cause more hypotension and bradycardia compared to midazolam or propofol 6.
• A study on healthy volunteers found that dexmedetomidine causes a significant dose-dependent reduction in blood pressure and heart rate, while midazolam does not affect blood pressure or heart rate 7.

Dosage and Administration

• The ED50 of dexmedetomidine administered over 5 s without significant hemodynamic compromise is 0.49 mcg·kg(-1) 3.
• The recommended dose of dexmedetomidine for sedation in mechanically ventilated patients is not specified, but it is generally well tolerated and effective in reducing the need for rescue sedation with intravenous propofol or midazolam 4, 5.
• The dose of dexmedetomidine used in ICU patients can vary, but it is typically administered as a continuous infusion 6.

Hemodynamic Effects

• Dexmedetomidine can cause hypotension and bradycardia, which usually resolve without intervention 4, 5, 6.
• A study found that dexmedetomidine causes a significant dose-dependent reduction in blood pressure and heart rate in healthy volunteers 7.
• The hemodynamic effects of dexmedetomidine can be monitored and managed with appropriate dosing and administration 3, 6.