Systematic (IUPAC) name
Clinical data
AHFS/ monograph
Pregnancy cat.  ?
Legal status  ?
Routes by intravenous infusion only
Pharmacokinetic data
Protein binding 94%
Metabolism near complete hepatic metabolism to inactive metabolites
Half-life 2 hours
Excretion urinary
CAS number 113775-47-6 YesY
ATC code N05CM18
PubChem CID 68602
DrugBank APRD00578
ChemSpider 4470605 YesY
KEGG D00514 YesY
Chemical data
Formula C13H16N2 
Mol. mass 200.28 g/mol
SMILES eMolecules & PubChem
 N(what is this?)  (verify)

Dexmedetomidine (Precedex) is a sedative medication used by intensive care units and anesthetists. It is relatively unique in its ability to provide sedation without causing respiratory depression. Like clonidine, it is an agonist of α2-adrenergic receptors in certain parts of the brain.[1]



Dexmedetomidine is indicated for sedation of critically ill or injured patients in an intensive care unit setting. Its indication in the US was recently expanded to include nonintubated patient requiring sedation for surgery or procedures short-term. It is also useful as an adjunct for sedation and general anesthesia in the setting of certain operations and invasive medical procedures, such as colonoscopy. There are no absolute contraindications to the use of dexmedetomidine. Limiting its usefulness is the caution that the drug cannot be bolused due to concerns about peripheral α2-receptor stimulation with resulting hypotension, combined with its high cost relative to generic medications like propofol, fentanyl and midazolam which can achieve similar clinical effects

Intensive care unit sedation

Compared to midazolam, dexmedetomidine was similarly effective for sedation, but shortened the time to extubation. It was associated with less delirium, tachycardia and hypotension. but more bradycardia. [2] It also seemed to be superior to lorazepam for ventilated patients in the intensive care unit.[3] Compared to midazolam, dexmedetomidine is superior due to reduced intensive care costs. The reduced costs are due to a reduction in intensive care unit stay as well as reduced mechanical ventilation.[4]

Procedural sedation

Dexmedetomidine has sedative, analgesic, sympatholytic, and anxiolytic effects that blunt many of the cardiovascular responses in the perioperative period. It reduces the requirements for volatile anesthetics, sedatives and analgesics without causing significant respiratory depression.[5]


Dexmedetomidine may be useful for the treatment of the deleterious cardiovascular effects of acute cocaine intoxication and overdose.[6] Dexmedetomidine may also offer a new paradigm in the pharmacologic treatment of symptoms of distress (intractable pain, agitation or delirium) at the end of life. Recently, an investigator initiated IND was approved by the FDA to examine the use of dexmedetomidine in treating cancer patients at the end of life who are suffering from intractable pain, agitation or delirium.[7]

Dosage and administration

Intravenous infusion of dexmedetomidine is commonly initiated with a 1 mcg/kg loading dose, administered over 10 minutes, followed by a maintenance infusion of 0.2–1.0 mcg/kg/hour. There may be great individual variability in the hemodynamic effects (especially on heart rate and blood pressure), as well as the sedative effects of this drug. For this reason, the dose must be carefully adjusted to achieve the desired clinical effect.[8]

See also


  1. ^ Cormack JR, Orme RM, Costello TG (2005). "The role of alpha2-agonists in neurosurgery". Journal of Clinical Neuroscience 12 (4): 375–8. doi:10.1016/j.jocn.2004.06.008. PMID 15925765. 
  2. ^ Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG (2009). "Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients: A Randomized Trial". JAMA 301 (5): 489–99. doi:10.1001/jama.2009.56. PMID 19188334. 
  3. ^ Pandharipande, PP; Pun, BT; Herr, DL; Maze, M; Girard, TD; Miller, RR; Shintani, AK; Thompson, JL et al. (2007). "Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial". JAMA 298 (22): 2644–53. doi:10.1001/jama.298.22.2644. PMID 18073360. 
  4. ^ O'Connor, M; Bucknall, T; Manias, E (2009). "Sedation Management in Australian and New Zealand Intensive Care Units: Doctors' and Nurses' Practices and Opinions". Am J Crit Care 19 (3): 285–95. doi:10.4037/ajcc2009541. PMID 19770414. 
  5. ^ Paris A, Tonner PH (2005). "Dexmedetomidine in anaesthesia". Current Opinion in Anaesthesiology 18 (4): 412–8. doi:10.1097/ PMID 16534267. 
  6. ^ Menon DV, Wang Z, Fadel PJ, Arbique D, Leonard D, Li JL, Victor RG, Vongpatanasin W (2007). "Central sympatholysis as a novel countermeasure for cocaine-induced sympathetic activation and vasoconstriction in humans". J Am Coll Cardiol 50 (7): 626–33. doi:10.1016/j.jacc.2007.03.060. PMID 17692748. 
  7. ^ Jackson KC, Wang Z, Wohlt P, Fine PG (2006). "Dexmedetomidine a novel analgesic with palliative medicine potential". J Pain and Palliative Care Pharmacotherapy 20 (2): 23–7. doi:10.1080/J354v20n02_05. PMID 16702133. 
  8. ^ "Dosing Guidelines for Precedex®". Retrieved 2010-11-21. 
  9. ^ PubChem 5311068

External links

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