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Class: Anxiolytics, Sedatives, and Hypnotics; Miscellaneous
- α2-Adrenergic Agonists
VA Class: CN309
Chemical Name: (S)-4-[1-(2,3-Dimethylphenyl)ethyl]-1H-imidazole monohydrochloride
Molecular Formula: C13H16N2•HCl
CAS Number: 145108-58-3
Brands: Precedex

Medically reviewed by Last updated on Jan 13, 2020.


Relatively selective α2-adrenergic agonist with sedative properties.1 2 3 4 5 6 7 8 13

Uses for Dexmedetomidine

Sedation in Critical Care Settings

Sedation of initially intubated and mechanically ventilated patients in an intensive care setting (i.e., ICU).1 800 801

May be used to provide mild to moderate levels of sedation, but not considered suitable for deep sedation.21 23 800 820

FDA-labeled for use only for short-term (<24 hours) sedation;1 however, has been used for prolonged sedation in the intensive care setting.23 801 817 818 819 820 (See Tolerance and Tachyphylaxis under Cautions.)

Produces sedation, anxiolysis, and analgesia without causing significant respiratory depression.24 801 817 818

Appears to be as effective as propofol and benzodiazepines (e.g., midazolam, lorazepam) for sedation in critically ill mechanically ventilated adults; however, because of some modest clinical benefits (e.g., reduced duration of mechanical ventilation, shorter time to extubation, reduced risk of delirium), nonbenzodiazepine sedatives (dexmedetomidine or propofol) are generally preferred to benzodiazepines.800 801 817 818 819 820

When selecting an appropriate sedative agent, consider patient's individual sedation goals in addition to specific drug-related (e.g., pharmacology, pharmacokinetics, adverse effects, availability, costs) and patient-related (e.g., comorbid conditions such as anxiety, seizures, or alcohol or benzodiazepine withdrawal) factors.23 24 800 801

Patients receiving dexmedetomidine are more arousable than those receiving other sedatives, which may be particularly useful for daily awakening trials.21 23 820

Because dexmedetomidine does not have a substantial respiratory depressant effect, infusions of the drug can be continued following extubation, if needed.1 801

Procedural Sedation

Sedation of nonintubated patients prior to and/or during surgical or other procedures.1 16 30 31 823

Comparative efficacy with other sedative agents not established.817 May be preferred in certain patients (e.g., those in whom respiratory compromise with benzodiazepines is a concern); however, consider risks versus benefits.817

Dexmedetomidine Dosage and Administration


  • Administer only by individuals experienced in the management of patients in an intensive care or surgical setting.1

  • Individualize dosage and titrate to desired level of sedation.1

  • Monitor patient continuously.1 15


IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by IV infusion.1

May adsorb to some types of natural rubber; use administration components made with synthetic or coated natural rubber gaskets.1

Commercially available as an injection concentrate that must be diluted prior to IV infusion or as a premixed ready-to-use solution (dexmedetomidine hydrochloride in 0.9% sodium chloride injection).1


Must dilute the injection concentrate in 0.9% sodium chloride injection prior to administration.1 To prepare the 4-mcg/mL concentration used for loading and maintenance infusions, one method of dilution is to add 2 mL of the concentrate (100 mcg/mL) to 48 mL of 0.9% sodium chloride injection.1

Rate of Administration

Administer by slow IV infusion via a controlled-infusion device.1

Rapid IV infusion associated with loss of α2-adrenergic selectivity1 and adverse cardiovascular effects.1 2 3 15 (See Actions and also see Cardiovascular Effects under Cautions.)


Available as dexmedetomidine hydrochloride; dosage is expressed in terms of dexmedetomidine.1


Sedation in Critical Care Settings

Initiation of sedation: 1 mcg/kg as a loading infusion over 10 minutes.1 Because of risk of adverse hemodynamic effects, many clinicians do not recommend a loading dose; if a loading dose is used, caution is advised, particularly in patients with bradycardia, heart block, or hemodynamic instability.21 22 25 801 817 Manufacturer states loading dose may not be required in patients converting from an alternative sedative agent.1

Maintenance of sedation: Continuous IV infusion at a rate of 0.2–0.7 mcg/kg per hour recommended.1 Adjust infusion rate to desired level of sedation;1 in most cases, a light rather than deep level of sedation is recommended in critically ill, mechanically ventilated patients.801 Assess depth and quality of sedation using a validated and reliable assessment tool.800 801 Adjust dosage slowly to reduce risk of hypotension and other adverse effects.24 817

Evidence from clinical studies supports use of infusion rates up to 1.5 mcg/kg per hour.23 24 801 817 818 819 820

Manufacturer states that continuous IV infusion of dexmedetomidine should not exceed 24 hours.1 817 However, the drug has been used for prolonged (>24 hours) sedation in the ICU.817 818 819 820

Procedural Sedation

Initiation of sedation: 1 mcg/kg as a loading infusion over 10 minutes.1 A loading infusion of 0.5 mcg/kg over 10 minutes may be suitable for less invasive procedures (e.g., ophthalmic surgery).1 For awake fiberoptic intubation, a loading infusion of 1 mcg/kg over 10 minutes is recommended.1

Maintenance of sedation: Initiate maintenance infusion at a rate of 0.6 mcg/kg per hour; adjust rate within range of 0.2–1 mcg/kg per hour to achieve desired level of sedation.1 For awake fiberoptic intubation in adults, a maintenance infusion of 0.7 mcg/kg per hour is recommended until endotracheal tube is secured.1

Special Populations

Hepatic Impairment

Consider dosage reduction.1

Renal Impairment

Manufacturer makes no special dosage recommendations.1

Geriatric Patients

For initiation and maintenance of ICU sedation in geriatric patients >65 years of age, consider dosage reduction.1

For procedural sedation in geriatric patients >65 years of age, reduce loading dose to 0.5 mcg/kg over 10 minutes; consider dosage reduction for maintenance of procedural sedation.1

Cautions for Dexmedetomidine


  • None.1


Administration Precautions

To minimize risk of adverse effects, follow recommendations for administration and monitoring of dexmedetomidine therapy.1 (See General under Dosage and Administration.)

Cardiovascular Effects

Bradycardia and sinus arrest reported in young, healthy adults with high vagal tone; also associated with other methods of administration, including rapid IV administration.1

Hypotension and/or bradycardia reported frequently; although intervention rarely required, some cases resulted in fatality.1 8 9 21 23 818 820 May be more pronounced in geriatric patients or those with hypovolemia, diabetes mellitus, or chronic hypertension.1 If treatment is required, consider slowing or stopping dexmedetomidine infusion, increasing IV fluids, elevating lower extremities, and/or use of vasopressors; consider IV anticholinergic agents (e.g., atropine sulfate, glycopyrrolate) to modify vagal tone.1 More advanced resuscitative measures may be necessary in patients with significant cardiovascular dysfunction.1

Transient hypertension reported with loading dose; treatment generally not required, although reduction in the loading dose infusion rate may be desirable.1

Supraventricular and ventricular tachycardia, atrial fibrillation, extrasystoles, and cardiac arrest reported during postmarketing experience.1 15

Use with caution in patients with (or at risk of) advanced heart block and/or severe ventricular dysfunction, and in patients receiving concomitant drugs that slow cardiac conduction.1 817

Withdrawal Effects

Abrupt withdrawal of dexmedetomidine may result in clonidine-like withdrawal symptoms.1 Withdrawal-related events (e.g., nausea, vomiting, agitation, tachycardia, hypertension) reported following discontinuance of therapy in some patients after prolonged (up to 7 days) infusion for ICU sedation.1 Withdrawal symptoms not reported with short-term (<6 hours) infusions for procedural sedation.1

If tachycardia and/or hypertension occurs after discontinuance of dexmedetomidine, institute supportive therapy.1


Some patients observed to be arousable and alert when stimulated; should not be considered as evidence of lack of efficacy in the absence of other signs and symptoms.1

Tolerance and Tachyphylaxis

Use of dexmedetomidine for durations >24 hours associated with tolerance, tachyphylaxis, and dose-related increase in adverse effects.1

Specific Populations


Category C.1

No adequate and well-controlled studies in pregnant women.1 No evidence of teratogenicity in animal studies; however, fetal toxicity (e.g., postimplantation loss, reduced pup viability, reduced pup weight) observed.1

Use during pregnancy only when potential benefits justify potential risks to fetus.1


Distributed into milk in rats; not known whether distributed into human milk.1 Caution if used in nursing women.1

Pediatric Use

Manufacturer states safety and efficacy not established in pediatric patients <18 years of age.1 However, the drug has been used in pediatric patients undergoing sedation in the ICU or other settings to facilitate mechanical ventilation or other procedures (e.g., radiologic imaging).25 26 27 Additional study is needed to evaluate the drug's safety in this population.21 25 26

Geriatric Use

Hypotension and/or bradycardia may be more pronounced.1 Consider dosage reduction.1 (See Geriatric Patients under Dosage and Administration.)

Renal Impairment

Pharmacokinetics in patients with severe renal impairment (Clcr <30 mL/minute) and healthy individuals are similar.1

Hepatic Impairment

Clearance may be reduced.1 Consider dosage reduction.1 (See Hepatic Impairment under Dosage and Administration.)

Common Adverse Effects

Short-term (<24 hours) infusions for ICU sedation: Hypotension, hypertension, nausea, bradycardia, fever, vomiting, hypovolemia, atelectasis, atrial fibrillation, hypoxia, tachycardia, hemorrhage, anemia, dry mouth.1

Long-term (>24 hours) infusions for ICU sedation: Hypotension, bradycardia, hypertension, tachycardia, hypokalemia, agitation, hyperglycemia, constipation, hypoglycemia, respiratory failure.1

Procedural sedation: Hypotension, respiratory depression, bradycardia, hypertension, tachycardia, nausea, dry mouth.1

Interactions for Dexmedetomidine

Metabolized by CYP isoenzymes, principally CYP2A6.1 However, no evidence of clinically important CYP-mediated drug interactions in vitro.1

Drugs with Negative Chronotropic Effects

Potential pharmacodynamic interaction (additive pharmacodynamic effects).1 Use with caution.1

Protein-bound Drugs

Pharmacokinetic interaction unlikely.1

Specific Drugs





Additive pharmacologic effects1 8

May require reduction in dosage of dexmedetomidine or concomitant drug1 8


Negligible change in dexmedetomidine protein binding in vitro; negligible displacement of digoxin from protein binding sites in vitro1

Possible additive hypotensive and bradycardic effects1 25

Caution is advised1


Negligible change in dexmedetomidine protein binding in vitro1


Negligible displacement of ibuprofen from protein binding sites in vitro1


Negligible change in dexmedetomidine protein binding in vitro1


Negligible change in dexmedetomidine protein binding in vitro1

Neuromuscular blocking agents

Increased plasma rocuronium concentrations1 12

No clinically important effect on neuromuscular blockade1 12

Opiate agonists

Additive pharmacologic effects1 8

May require reduction in dosage of dexmedetomidine or concomitant drug1 8


Negligible displacement of phenytoin from protein binding sites in vitro1


Negligible displacement of propranolol from protein binding sites in vitro1


Additive pharmacologic effects1 8

May require reduction in dosage of dexmedetomidine or concomitant drug1 8


Negligible change in dexmedetomidine protein binding in vitro; negligible displacement of theophylline from protein binding sites in vitro1


Possible additive hypotensive effects1

Use with caution1


Negligible displacement of warfarin from protein binding sites in vitro1

Dexmedetomidine Pharmacokinetics



Rapidly distributed.1 Rapidly crosses blood-brain barrier.25

Crosses the placenta and is distributed into milk in rats.1

Plasma Protein Binding

Approximately 94%.1



Undergoes almost complete biotransformation by direct glucuronidation, aliphatic hydroxylation by CYP2A6, and N-methylation.1 15

Elimination Route

Excreted in urine (95%) and feces (4%).1


Terminal elimination half-life is approximately 2 hours.2 3 6

Special Populations

Clearance decreases with increasing severity of hepatic impairment.1 In patients with mild, moderate, or severe hepatic impairment, mean clearance values were 74, 64, or 53%, respectively, of those in healthy individuals.1

Pharmacokinetics in patients with severe renal impairment (Clcr <30 mL/minute) not substantially altered.1




Injection Concentrate

25°C (may be exposed to 15–30°C).1

Premixed Injection in 0.9% Sodium Chloride Injection

25°C (may be exposed to 15–30°C).1


For information on systemic interactions resulting from concomitant use, see Interactions.

Should not be infused through the same IV line with blood or plasma.1


Solution Compatibility


Dextrose 5%

Ringer’s injection lactated

Sodium chloride 0.9%

Drug Compatibility
Y-Site Injection Compatibility

Compatible1 HID

Alfentanil HCl

Amikacin sulfate


Amiodarone HCl

Ampicillin sodium

Ampicillin sodium-sulbactam sodium

Atracurium besylate

Atropine sulfate




Butorphanol tartrate

Calcium gluconate

Cefazolin sodium

Cefepime HCl

Cefotaxime sodium

Cefotetan disodium

Cefoxitin sodium


Ceftolozane sulfate-tazobactam sodium

Ceftriaxone sodium

Cefuroxime sodium

Chlorpromazine HCl


Cisatracurium besylate

Clindamycin phosphate


Dexamethasone sodium phosphate


Diltiazem HCl

Diphenhydramine HCl

Dobutamine HCl

Dolasetron mesylate

Dopamine HCl

Doxycycline hyclate



Ephedrine sulfate

Epinephrine HCl

Erythromycin lactobionate

Esmolol HCl



Fenoldopam mesylate

Fentanyl citrate



Gentamicin sulfate


Granisetron HCl

Haloperidol lactate

Heparin sodium

Hydrocortisone sodium succinate

Hydromorphone HCl

Hydroxyzine HCl

Isavuconazonium sulfate

Isoproterenol HCl

Ketorolac tromethamine

Labetalol HCl


Lidocaine HCl



Magnesium sulfate

Mannitol 20%

Meperidine HCl


Methylprednisolone sodium succinate

Metoclopramide HCl


Midazolam HCl

Milrinone lactate

Morphine sulfate

Nalbuphine HCl


Norepinephrine bitartrate

Ondansetron HCl

Oritavancin diphosphate

Pancuronium bromide

Phenylephrine HCl

Piperacillin sodium-tazobactam sodium

Potassium chloride

Procainamide HCl

Prochlorperazine edisylate

Promethazine HCl


Ranitidine HCl

Remifentanil HCl

Rocuronium bromide

Sodium bicarbonate

Sodium nitroprusside

Succinylcholine chloride

Sufentanil citrate

Tedizolid phosphate


Tobramycin sulfate

Vancomycin HCl

Vecuronium bromide

Verapamil HCl


Amphotericin B



  • Dose-related sedative, anxiolytic, analgesic, and anesthetic-sparing effects;2 3 5 6 8 13 does not appear to reduce dosage requirements of skeletal muscle relaxants.3 12

  • Helps maintain intraoperative hemodynamic stability by blunting sympathetic response to surgery.2 3 5 6 8 13

  • Does not cause respiratory depression in healthy individuals when given by IV infusion in recommended dosages.1

  • Compared with clonidine, dexmedetomidine has a shorter half-life2 3 5 (about 2 versus 8–12 hours)2 3 6 and greater α2-selectivity, with potential for reduced incidence of undesirable α1-adrenergic effects (e.g., hypotension, bradycardia).3

  • Exhibits α2-selectivity when given by slow IV infusion in low to moderate doses (10–300 mcg/kg); selectivity diminishes at 12 high doses (e.g., 1000 mcg/kg) or with rapid IV administration.1

Advice to Patients

  • When dexmedetomidine hydrochloride is used for short-term IV sedation, dosage must be individualized and titrated to the desired clinical effect.1 BP, heart rate, and oxygen concentrations are continuously monitored during the infusion and as clinically appropriate after discontinuance.1

  • Risk of withdrawal reactions and other adverse effects.1 When dexmedetomidine is infused for >6 hours, patients should report any nervousness, agitation, and/or headaches that may occur for up to 48 hours following dexmedetomidine administration to their clinician.1 In addition, patients should report symptoms that may occur within 48 hours following administration (e.g., weakness, confusion, excessive sweating, weight loss, abdominal pain, salt cravings, diarrhea, constipation, dizziness, lightheadedness) to their clinician.1

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant diseases.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of informing patients of other important precautionary information. (See Cautions.)1


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dexmedetomidine Hydrochloride


Dosage Forms


Brand Names



For injection concentrate, for IV infusion

100 mcg (of dexmedetomidine) per mL*

Dexmedetomidine Hydrochloride Injection (available in single-dose and multiple-dose vials)

Precedex Injection


* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dexmedetomidine Hydrochloride in Sodium Chloride


Dosage Forms


Brand Names



Injection, for IV infusion

4 mcg (of dexmedetomidine) per mL (80, 200, or 400 mcg) in sodium chloride 0.9%*

Dexmedetomidine Hydrochloride in 0.9% Sodium Chloride Injection

Precedex in 0.9% Sodium Chloride Injection


AHFS DI Essentials™. © Copyright 2021, Selected Revisions January 13, 2020. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.


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2. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia. 1999; 54:146-65.

3. Kamibayashi T, Harasawa K, Maze M. Alpha-2 adrenergic agonists. Can J Anaesth. 1997; 44:R13-R18.

4. Peden CJ, Prys-Roberts C. Dexmedetomidine—a powerful new adjunct to anaesthesia? Br J Anaesth. 1992; 68:123-5. Editorial.

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6. Jalonen J, Hynynen M, Kuitunen A et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 1997; 86:331-45.

7. Aho M, Lehtinen A-M, Erkola O et al. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology. 1991; 74:997-1002.

8. Aho MS, Erkola OA, Scheinin H et al. Effect of intravenously administered dexmedetomidine on pain after laparoscopic tubal ligation. Anesth Analg. 1991; 73:112-8.

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11. Jaakola M-L, Ali-Melkkila T, Kanto J et al. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth. 1992; 68:570-5.

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16. Mylan. Dexmedetomidine hydrochloride injection prescribing information. Rockford, IL; 2017 Jan.

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30. Bergese SD, Candiotti KA, Bokesch PM et al. A Phase IIIb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fiberoptic intubation. Am J Ther. 2010 Nov-Dec; 17:586-95.

31. Candiotti KA, Bergese SD, Bokesch PM et al. Monitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial. Anesth Analg. 2010; 110:47-56.

32. WG Critical Care. Dexmedetomidine hydrochloride injection prescribing information. Paramus, NJ; 2016 Sept.

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801. Barr J, Fraser GL, Puntillo K et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41:263-306.

817. Gerlach AT, Murphy CV, Dasta JF. An updated focused review of dexmedetomidine in adults. Ann Pharmacother. 2009; 43:2064-74.

818. Riker RR, Shehabi Y, Bokesch PM et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009; 301:489-99.

819. Pandharipande PP, Pun BT, Herr DL et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007; 298:2644-53.

820. Jakob SM, Ruokonen E, Grounds RM et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012; 307:1151-60.

821. Godwin SA, Caro DA, Wolf SJ et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005; 45:177-96.

822. Godwin SA, Burton JH, Gerardo CJ et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014; 63:247-58.e18.

823. . Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018; 128:437-479.

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