Dexmedetomidine

Central Alpha-2 Agonist·Psychiatry - Acute Calming & Sedation

Sedation of initially intubated and mechanically ventilated patients in ICU

ICU IV ONLYPrecedexVials (200 mcg/2 mL) for IV…S4TGA

Max Dose

1.4 mcg/kg/hr

Half-life

2 h

Airway

PRESERVED

Bradycardia

HIGH RISK

Rapid Summary

Overview

Highly selective central alpha-2 agonist. Provides unique 'rousable sedation' (cooperative sedation) and analgesia without depressing respiratory drive.

Maximum Dose

Max 1.4 mcg/kg/hr (via continuous IV infusion).

Clinical Focus

Frequently causes profound bradycardia and hypotension. Strictly for ICU/OT use.

Bottom Line

Dexmedetomidine is a selective alpha-2 agonist for ICU sedation allowing cooperative sedation without respiratory depression, but causes significant bradycardia and hypotension.

Formulation & Access

Brand Names

Precedex

Parenteral

Vials (200 mcg/2 mL) for IV infusion. Must be diluted.

Prescribing & PBS

Hospital ICU/OT supply only. S4.

Indications & Use

Primary

TGA

Sedation of initially intubated and mechanically ventilated patients in ICU. Procedural sedation.

Clinical Place

Allows for early extubation in ICU because the patient can be awake and cooperative while still comfortable, unlike Propofol which induces a coma.

Quick reference

Class & Role

Central Alpha-2 Agonist — Highly selective central alpha-2 agonist.

Route / Formulation

Vials (200 mcg/2 mL) for IV infusion. Must be diluted. (Precedex)

Usual Dose & Max

IV Infusion Start at 0.2 - 0.7 mcg/kg/hr. Titrate to desired RASS (Richmond Agitation-Sedation Scale) score. Loading doses (1 mcg/kg over 10 mins) are increasingly avoided due to severe bradycardia risk. Max 1.4 mcg/kg/hr (via continuous IV infusion).

Key Indication Doses

ICU Sedation: IV Infusion Start at 0.2 - 0.7 mcg/kg/hr. Titrate to desired RASS (Richmond Agitation-Sedation Scale) score. Loading doses (1 mcg/kg over 10 mins) are increasingly avoided due to severe bradycardia risk. Hepatic Impairment: Reduce dose in severe liver disease (prolonged clearance).

Best Uses

Dexmedetomidine is a selective alpha-2 agonist for ICU sedation allowing cooperative sedation without respiratory depression, but causes significant bradycardia and hypotension.

Avoid / Cautions

Severe baseline bradycardia, advanced heart block without a pacemaker, unresuscitated hypovolemia.

Key Risks

Cardiovascular: Severe bradycardia (can lead to sinus arrest), hypotension. (A transient hypertensive spike can occur if a rapid loading dose is given). Respiratory: Zero clinically significant respiratory depression. Gastrointestinal: Dry mouth, nausea.

Key Interactions

Beta-blockers, Digoxin, Amiodarone (Massive additive bradycardia risk). Enhances the effect of opioids and propofol, requiring their doses to be slashed.

Monitoring

Continuous ECG and BP monitoring. Stop infusion if HR drops dangerously low.

Clinical Pearl

A patient on a Dexmedetomidine infusion might look deeply asleep, but if you say their name, they will open their eyes, follow commands, and then drift back to sleep. This makes neuro-assessments in ICU incredibly easy compared to Midazolam/Propofol.

Access

Precedex

Brand: Precedex

Dexmedetomidine

Central Alpha-2 Agonist·Psychiatry - Acute Calming & Sedation

Sedation of initially intubated and mechanically ventilated patients in ICU

ICU IV ONLYPrecedexVials (200 mcg/2 mL) for IV…S4TGA

Max Dose

1.4 mcg/kg/hr

Half-life

2 h

Airway

PRESERVED

Bradycardia

HIGH RISK

Rapid Summary

Overview

Highly selective central alpha-2 agonist. Provides unique 'rousable sedation' (cooperative sedation) and analgesia without depressing respiratory drive.

Maximum Dose

Max 1.4 mcg/kg/hr (via continuous IV infusion).

Clinical Focus

Frequently causes profound bradycardia and hypotension. Strictly for ICU/OT use.

Bottom Line

Dexmedetomidine is a selective alpha-2 agonist for ICU sedation allowing cooperative sedation without respiratory depression, but causes significant bradycardia and hypotension.

Formulation & Access

Brand Names

Precedex

Parenteral

Vials (200 mcg/2 mL) for IV infusion. Must be diluted.

Prescribing & PBS

Hospital ICU/OT supply only. S4.

Indications & Use

Primary

TGA

Sedation of initially intubated and mechanically ventilated patients in ICU. Procedural sedation.

Clinical Place

Allows for early extubation in ICU because the patient can be awake and cooperative while still comfortable, unlike Propofol which induces a coma.

Quick reference

Class & Role

Central Alpha-2 Agonist — Highly selective central alpha-2 agonist.

Route / Formulation

Vials (200 mcg/2 mL) for IV infusion. Must be diluted. (Precedex)

Usual Dose & Max

Key Indication Doses

Best Uses

Dexmedetomidine is a selective alpha-2 agonist for ICU sedation allowing cooperative sedation without respiratory depression, but causes significant bradycardia and hypotension.

Avoid / Cautions

Severe baseline bradycardia, advanced heart block without a pacemaker, unresuscitated hypovolemia.

Key Risks

Key Interactions

Beta-blockers, Digoxin, Amiodarone (Massive additive bradycardia risk). Enhances the effect of opioids and propofol, requiring their doses to be slashed.

Monitoring

Continuous ECG and BP monitoring. Stop infusion if HR drops dangerously low.

Clinical Pearl

Access

Precedex

Brand: Precedex