Bedside Snapshot
- Use It For
- Light sedation of ventilated ICU adults; sedation of non-intubated adults and children for procedures; awake fiberoptic intubation; agitated delirium blocking extubation (off-label)
- Adult Dose
- ICU: 1 mcg/kg IV over 10 min (label; often omitted, not needed when converting from another sedative), then 0.2–0.7 mcg/kg/hr
- Procedural: 1 mcg/kg IV over 10 min, then 0.6 mcg/kg/hr (0.2–1)
- Pediatric Dose
- Procedural, 1 month–17 yr: 1.5 mcg/kg (under 2 yr) or 2 mcg/kg IV over 10 min, then 0.5–1.5 mcg/kg/hr. IN 2 to <3 mcg/kg (off-label). PICU sedation not FDA-established
- Onset / Duration
- IV: 15–20 min after the load; without a load, effect builds over hours / offset varies with infusion length (T½ about 2 hr); IN: 15–45 min / 1–2 hr
- Do Not Give / Hold If
- No labeled contraindications. Adults: HR <50/min, reduce the rate; bradycardia with hypotension, poor perfusion or pauses, stop. MAP <65 mmHg despite fluids; children HR or SBP 30% below baseline; AV block without pacer
- Watch For
- Bradycardia and sinus arrest (ECG); hypotension (BP); hypertension during the load; withdrawal agitation, tachycardia and hypertension after stopping; polyuria with rising Na⁺ (diabetes insipidus)
- Reversal / Rescue
- No reversal agent. Slow or stop the infusion; fluids, leg elevation, vasopressor; atropine or glycopyrrolate for bradycardia; pacing or ACLS if unstable
- Must Remember
- Never bolus: run any load over 10 min on a pump, or skip it; a rapid push causes bradycardia and sinus arrest. Program mcg/kg/hr and confirm the 4 mcg/mL premix
Indications
ED / ICU / Transport
- Sedation of intubated, mechanically ventilated adults: The label covers ICU sedation. When light sedation is the goal, reach for this one first in a ventilated adult. The 2025 PADIS focused update makes it a conditional recommendation over propofol.
- Sedation of non-intubated adults for procedures: The label covers it, awake fiberoptic intubation included.
- Procedural sedation in children 1 month to 17 years: Labeled for non-invasive procedures. MRI is the example.
- Agitated delirium that blocks ventilator weaning or extubation: The 2018 PADIS guideline made a conditional suggestion here. Off-label.
- Analgosedation adjunct: An opioid-sparing partner when the strategy is analgesia first. Morphine needs came down in the label ICU trials.
- Agitated patients on high-flow oxygen or noninvasive ventilation: Opioids and other sedatives add to the respiratory depression. Continuous SpO₂ and EtCO₂ and airway backup are required. Off-label and protocol-dependent.
- Intubated patients during extubation: The label lets the infusion run through extubation and beyond it.
Other Uses
- Acute agitation in schizophrenia or bipolar I or II disorder (adults): That is the sublingual film (Igalmi), not the IV product.
- Alcohol withdrawal: An adjunct for agitation and autonomic overactivity, and never the only drug. Off-label.
- Pediatric intranasal sedation and premedication: Off-label, and for specialists only.
Dosing & Administration
Every dose below is a label dose unless it is marked off-label.
Available Forms
- Concentrate vial: 100 mcg/mL in 2 mL (200 mcg) single-dose vial. It must be diluted before IV use. Off-label IN doses are drawn from it.
- Ready-to-use vial: 4 mcg/mL in 20 mL (80 mcg) in 0.9% sodium chloride
- Ready-to-use bottles and bags: 4 mcg/mL in 50 mL (200 mcg), 100 mL (400 mcg) and 250 mL (1,000 mcg); the form usually running at interfacility transfer
- Sublingual film (Igalmi): 120 mcg and 180 mcg films; can be cut in half for 60 mcg or 90 mcg doses
High-Alert Medication: ISMP lists IV moderate-sedation agents, and dexmedetomidine is named. Three traps catch people. The 100 mcg/mL concentrate and the 4 mcg/mL premix are 25-fold apart. A load gets entered as a bolus. mcg/kg/hr gets entered as mcg/kg/min, which is the propofol unit. Double-check each one independently: concentration, weight, dose unit and pump programming.
Adult Dosing
| Indication | Dose & Route | Repeat / Max | Notes |
|---|---|---|---|
| ICU sedation, ventilated adults | Load 1 mcg/kg IV over 10 min (label; may be omitted when converting from another sedative, and often omitted per protocol), then 0.2–0.7 mcg/kg/hr IV infusion | Label max 0.7 mcg/kg/hr for up to 24 hr; off-label up to 1.4 mcg/kg/hr (European label maximum) per ICU protocol | High-alert Skipping the load is common practice; the label omits it only when converting from another sedative. Label names no dosing weight (see Special Populations). |
| Procedural sedation, non-intubated adults | 1 mcg/kg IV over 10 min, then 0.6 mcg/kg/hr IV, titrated 0.2–1 mcg/kg/hr | Max 1 mcg/kg/hr (label range); load 0.5 mcg/kg over 10 min may suffice for less invasive procedures | High-alert Pair with analgesia or local anesthesia. Continuous SpO₂, EtCO₂, ECG and BP. |
| Awake fiberoptic intubation | 1 mcg/kg IV over 10 min, then 0.7 mcg/kg/hr IV until the tube is secured | Single load; stop or reassess once the tube is secured | High-alert Airway team and rescue plan ready before starting. |
| Older adults (over 65 yr) | Procedural: 0.5 mcg/kg IV over 10 min, then a reduced maintenance rate | Stay within the label ranges above; ICU: consider dose reduction | High-alert More bradycardia and hypotension than in younger adults (label). |
| Agitated delirium blocking weaning (off-label) | 0.2–0.7 mcg/kg/hr IV infusion, usually without a load | Titrate to the RASS target; off-label max per ICU protocol | High-alert Treat pain and look for causes of delirium first. |
| Acute agitation, schizophrenia or bipolar (Igalmi film) | 120 mcg (mild–moderate) or 180 mcg (severe) SL or buccal; age 65 yr or older: 120 mcg | Up to 2 more doses (60 mcg mild–moderate, 90 mcg severe) at least 2 hr apart; max 240 mcg/day mild–moderate, 360 mcg/day severe, 240 mcg/day at 65 yr or older | Not a substitute for IV sedation. Do not repeat if SBP <90 mmHg, DBP <60 mmHg, HR <60/min or orthostatic drop. Lower doses in hepatic impairment (label). |
Pediatric Dosing
| Indication | Dose (per kg) & Route | Max Single / Max Total | Notes |
|---|---|---|---|
| Procedural sedation, 1 month to under 2 yr | 1.5 mcg/kg IV over 10 min, then 1.5 mcg/kg/hr IV, titrated 0.5–1.5 mcg/kg/hr | Max 1.5 mcg/kg/hr (label); reduce the load if clinically indicated | High-alert Label MRI study (1 month–17 yr): bradypnea 67%, bradycardia 62%, hypertension 38%, hypotension 25%; bradycardia and hypertension rose with dose; no child needed airway intervention. Act on a fall of 30% or more in HR or SBP, or values below age norms; continuous ECG, SpO₂, EtCO₂ and respiratory rate. |
| Procedural sedation, 2 to 17 yr | 2 mcg/kg IV over 10 min, then 1.5 mcg/kg/hr IV, titrated 0.5–1.5 mcg/kg/hr | Max 1.5 mcg/kg/hr (label); reduce the load if clinically indicated | High-alert Same monitoring and triggers as the row above. Brief emergence agitation can follow short infusions. |
| Procedural sedation, intranasal (off-label, specialist use) | 2 to <3 mcg/kg IN by atomizer, split between nares | Pooled RCTs support 2 to <3 mcg/kg; 3 mcg/kg or more, any absolute mcg cap and repeat dosing per protocol only; max 1 mL per naris | Onset about 15–45 min: give well before the scan. Pooled trials: hypotension 8%, bradycardia 5%, desaturation 3%. |
| ICU sedation (PICU) | Not established in children (FDA): PICU specialist protocol only | — | The 2022 SCCM PANDEM guideline suggests α2-agonists as the primary sedative class for ventilated PICU patients (conditional, low certainty); rates per PICU protocol. Patients may arrive on an infusion at transfer: confirm the protocol rate and weight used. |
| Neonates (under 1 month) | Not established in children under 1 month (FDA) | — | Neonatal use is NICU-specialist only. |
| Igalmi sublingual film | Not established in children | — | — |
See Pediatric Weight-Based Dosing.
Continuous Infusion
| Setting | Example Concentration | Start | Titrate | Usual Range / Max |
|---|---|---|---|---|
| Adult ICU sedation | 4 mcg/mL (example, institution-specific) | Within 0.2–0.7 mcg/kg/hr; low end if frail or hemodynamically fragile | To the RASS target; interval per protocol | 0.2–0.7 mcg/kg/hr (label); up to 1.4 mcg/kg/hr off-label |
| Adult procedural sedation | 4 mcg/mL (example, institution-specific) | 0.6 mcg/kg/hr after the load | 0.2–1 mcg/kg/hr | Max 1 mcg/kg/hr |
| Pediatric procedural sedation | 4 mcg/mL (example, institution-specific) | 1.5 mcg/kg/hr after the load | 0.5–1.5 mcg/kg/hr | Max 1.5 mcg/kg/hr |
Preparation & Administration
- Dilution: concentrate only: add 2 mL (200 mcg) to 48 mL 0.9% sodium chloride for 50 mL at 4 mcg/mL and mix gently. Premixed 4 mcg/mL products need no dilution.
- Loading dose: run as an infusion over 10 min on the pump; never IV push. Slow the load if transient hypertension appears.
- Pump requirement: controlled infusion device only, programmed in mcg/kg/hr.
- Line: Do not run it through the same catheter as blood or plasma. Avoid natural-rubber components, since the drug is absorbed into them.
- Intranasal: Use an atomizer, max 1 mL per naris (off-label). Draw IN doses from the 100 mcg/mL concentrate per protocol. Not from the 4 mcg/mL premix, since 2 mL of premix holds only 8 mcg. Worked example: 15 kg × 2.5 mcg/kg = 37.5 mcg = 0.375 mL of 100 mcg/mL. The dilution rule is for IV use only.
- Sublingual film (Igalmi): give under healthcare-provider supervision. Place under the tongue (sublingual) or behind the lower lip (buccal) until dissolved; do not chew or swallow. No eating or drinking for 15 min after sublingual or 1 hr after buccal use. Monitor vital signs and alertness to prevent falls and syncope; the patient walks only when alert and not orthostatic. No driving or hazardous tasks for at least 8 hr.
Contraindications & Precautions
Contraindications
- None listed in the FDA label (IV or sublingual film).
- Avoid (relative): second- or third-degree AV block without a functioning pacemaker; severe hypotension or shock not yet resuscitated; a need for deep sedation (for example during neuromuscular blockade).
Precautions
- Bradycardia and sinus arrest: high vagal tone, rapid IV or bolus dosing, advanced heart block and severe ventricular dysfunction.
- Hypotension: more pronounced with hypovolemia, diabetes, chronic hypertension and age over 65.
- Use beyond 24 hr or above 0.7 mcg/kg/hr: tolerance, tachyphylaxis and more adverse effects (respiratory failure, atrial fibrillation).
- Hepatic impairment: clearance falls; reduce the dose.
- Igalmi film: avoid with hypotension, heart block, severe ventricular dysfunction, syncope history, QT-prolonging drugs or torsades risk.
Hold / Reassess If
- Adults, HR <50/min: reduce the rate. Any bradycardia with hypotension, poor perfusion or pauses: stop and treat (Reversal / Rescue).
- Adults, MAP <65 mmHg or SBP <90 mmHg: reduce or stop, give fluids, start a vasopressor if needed.
- Children, HR or SBP 30% or more below baseline, or below age-specific norms: reduce or stop. Bradycardia with poor perfusion: stop the infusion, give oxygen and ventilation, and follow PALS bradycardia care, with CPR if HR stays <60/min with poor perfusion.
- Children, slowed breathing, falling SpO₂ or rising EtCO₂: stimulate, support the airway, reduce or stop.
- New AV block or pauses on the monitor: stop the infusion.
- RASS deeper than the target, or deep sedation now needed: reduce, or change agent.
Treat the adult thresholds as examples and follow the ordered targets. Pediatric triggers come from the label study definitions.
Never Bolus: A fast push is how you get bradycardia and sinus arrest. In the label, an undiluted 19.4 mcg/kg bolus caused cardiac arrest. Run any load over 10 min on a pump, or leave it out.
Adverse Effects & Toxicity
Common
- Hypotension: 25% in label ICU trials; 54% in adult procedural sedation
- Hypertension: 12% in ICU trials, mostly during the load
- Bradycardia: 5% in ICU trials, 14% in procedural sedation, 42% in a longer ICU study
- Nausea: 9%; dry mouth 4%; atrial fibrillation 4%
- Agitation: happens more often than with propofol in the A2B trial
Serious / Life-Threatening
| Effect | Recognition | Management |
|---|---|---|
| Bradycardia, sinus arrest, AV block | HR trend, pauses, junctional rhythm on ECG; worse with vagal stimuli (suctioning, turning) | Slow or stop; atropine or glycopyrrolate; pacing or ACLS if unstable |
| Hypotension | MAP or SBP fall, especially with a load, hypovolemia or older age | Slow or stop, fluids, leg elevation, vasopressor |
| Transient hypertension | BP rise during the load (peripheral vasoconstriction) | Usually no treatment; slow the load |
| Withdrawal after stopping | Nausea, vomiting, agitation or nervousness, headache, tachycardia and hypertension within 48 hr | Supportive care; restart or wean per protocol |
| Diabetes insipidus | Urine output >125 mL/hr, urine osmolality <300 mOsm/kg, serum Na⁺ >145 mmol/L (label) | Adjust fluids, supportive care, consider stopping; usually resolves after stopping, often after 24 hr. Expert consult if it persists or the infusion has been long |
| Hyperthermia | Fever that resists cooling | Stop the drug; monitor until temperature normalizes |
Overdose & Toxicity Management
- Signs: bradycardia, first- or second-degree AV block, hypotension, oversedation; cardiac arrest after a large bolus (label).
- Immediate management: stop the infusion; airway and ventilatory support; fluids and a vasopressor for hypotension.
- Bradycardia: atropine or glycopyrrolate IV per the bradycardia algorithm; transcutaneous pacing if refractory and unstable.
- No antidote: No reversal agent is approved for humans. How long it lasts depends on clearance: T½ is about 2 hr, and it runs longer in liver disease.
Monitoring
| Parameter | When / How Often | Target / Act If |
|---|---|---|
| Clinical: ECG and HR | Continuous (label) | Adults HR <50/min: reduce the rate. Any bradycardia with hypotension, poor perfusion or pauses, or new AV block: stop and treat. Children HR 30% below baseline or under age norms: reduce or stop |
| Clinical: BP | Frequently during the load and each titration, then per protocol | Adults MAP <65 mmHg; children SBP 30% below baseline or under age norms: reduce, fluids, vasopressor |
| Clinical: sedation (RASS) | Before starting, after each titration and per ICU routine | Off the prescribed light target (for example RASS −2 to +1): titrate; deep sedation needed: change agent |
| Clinical: pain (CPOT or BPS) | With every RASS check | Pain present: treat it before raising the dexmedetomidine rate |
| Clinical: delirium (CAM-ICU or ICDSC) | Every shift | Positive: look for causes, minimize deliriogenic drugs |
| Clinical: SpO₂, EtCO₂ and respiratory rate (non-intubated) | Continuous during procedural or NIV sedation and in every sedated child | Slowed breathing, desaturation or rising EtCO₂, especially with co-sedatives: reduce, airway support |
| Laboratory: Na⁺ and urine output | Urine output hourly; Na⁺ per ICU routine, during and after the infusion | Urine output >125 mL/hr, urine osmolality <300 mOsm/kg and Na⁺ >145 mmol/L: suspect diabetes insipidus |
| Clinical: temperature | With routine vital signs | Fever resisting cooling: stop the drug, evaluate |
| Infusion safety: after stopping | For 48 hr after stopping, especially after infusions over 6 hr | Agitation, vomiting, tachycardia, hypertension: treat; restart or wean per protocol. Also ask about, and tell the patient to report, nervousness, headache, weakness, confusion, sweating, abdominal pain, salt craving or dizziness (label counseling) |
| Infusion safety: pump | Every titration and every handoff | Confirm 4 mcg/mL, mcg/kg/hr and the weight entered |
Interactions & Compatibility
Clinically Significant Interactions
| Drug / Class | Effect | What To Do |
|---|---|---|
| Opioids, propofol, benzodiazepines, volatile anesthetics | Additive sedation; more apnea risk in non-intubated patients | Lower the dose of either drug; monitor SpO₂ and EtCO₂ |
| Beta-blockers, diltiazem, verapamil, digoxin | Additive bradycardia and AV block | Avoid loads; start low; continuous ECG |
| Vasodilators and antihypertensives | Additive hypotension | Start low; fluids or vasopressor ready |
| QT-prolonging drugs (Igalmi film) | QT prolongation (sublingual label warning) | Avoid the combination; ECG if unavoidable |
| Neuromuscular blockers | No meaningful change in rocuronium block (label) | No adjustment; dexmedetomidine alone is not deep sedation for a paralyzed patient |
IV Compatibility
- Compatible fluids (label): 0.9% sodium chloride, D5W, lactated Ringer's, 20% mannitol, magnesium sulfate 100 mg/mL, 0.3% potassium chloride.
- Incompatible: amphotericin B and diazepam.
- Blood and plasma: Do not share the catheter. Compatibility is not established.
- Verify with an institutional compatibility resource.
Special Populations
- Pediatrics: FDA-labeled for procedural sedation from 1 month to 17 years. PICU sedation is not FDA-established. The 2022 SCCM PANDEM guideline suggests α2-agonists as the primary PICU sedative class, conditional. The label's MRI-study adverse events and doses are in the Pediatric Dosing table.
- Neonates: Not established under 1 month. NICU use is for specialists only.
- Pregnancy: Published data, mostly after the first trimester or at caesarean delivery, show no drug-associated risk of major birth defects or miscarriage. The drug crosses the placenta. In rats, fetal toxicity appeared at 1.8 times the maximum human dose during organogenesis. Developmental toxicity appeared at doses below the clinical dose given from late pregnancy through lactation. It showed as lower offspring weight, lower grip strength and implantation loss. No malformations were seen. Weigh the maternal need for sedation against these data.
- Lactation: It passes into milk, at a low relative infant dose (under 0.1%). Watch the breastfed infant for irritability.
- Older Adults: Over 65 years, expect more bradycardia and hypotension. Procedural hypotension runs 72% vs 47% under 65. For procedures, load 0.5 mcg/kg. In the ICU, consider lower rates. For Igalmi, 120 mcg.
- Renal Impairment: No specific adjustment is established. Pharmacokinetics were not significantly different at CrCl <30 mL/min. The renally cleared metabolites are inactive.
- Hepatic Impairment: Clearance falls to about 74%, 64% and 53% of normal in mild, moderate and severe impairment. T½ rises to about 4, 5 and 7 hr. Reduce IV doses. The Igalmi doses are lower in hepatic impairment.
- Obesity / Dosing Weight: The label gives no dosing weight. Body size changes distribution and clearance, and protocols use actual or adjusted body weight. Titrate to effect and to hemodynamics.
- Alcohol Withdrawal: It has no GABA activity, so it does not treat the withdrawal itself. Use it only alongside a benzodiazepine or phenobarbital.
Field & Transport Considerations
- Scope: Critical-care transport and flight RN and paramedic teams usually continue an infusion the sending facility started. Ground EMS starting one is uncommon. The label (5.1) limits giving it to clinicians skilled in ICU or OR-level patient management, with continuous monitoring. Agency credentialing and protocol have to cover this. It varies by state and agency protocol.
- Storage & Stability: 20–25 °C (68–77 °F), excursions 15–30 °C (59–86 °F). Do not use if discolored or if precipitate is visible.
- Carried Concentration: confirm a 4 mcg/mL premix for IV use; the 100 mcg/mL concentrate must be diluted. Program in mcg/kg/hr, never mcg/kg/min.
- Infusions in Transport: smart pump with drug library, enough volume for the trip plus delays, a line separate from blood products. Do not start a loading dose during movement unless protocol directs.
- Bradycardia and Hypotension in Transport: Moving the patient, suctioning and repositioning all act as vagal and hemodynamic stressors. Before departure, confirm stable HR and MAP on the current rate. Have atropine and a vasopressor ready. Consider pacing pads in patients who have already had bradycardia.
- Agitation En Route: Onset is 15–20 min. That is too slow to rescue acute agitation or a self-extubation risk, so use a faster agent per protocol. It is not an induction or RSI agent. Brief arousal to stimulation is expected.
- Handoff Essentials: rate in mcg/kg/hr, weight used, concentration, start time and any load, RASS target and last score, CAM-ICU, bradycardia or hypotension events, other sedatives and analgesics.
Clinical Pearls
PADIS 2025 vs the A2B Trial: PADIS 2025 gives dexmedetomidine a conditional nod over propofol in ventilated adults. The later A2B trial (1,404 UK adults, light-sedation target) saw no faster extubation (subdistribution HR 1.09, 95% CI 0.96 to 1.25). What it did see was more agitation (RR 1.54) and heart rate below 50/min (RR 1.62). Our house default: dexmedetomidine for light sedation. Use propofol when deeper sedation or rapid titration is needed, or when bradycardia or heart block is the worry.
Arousable by Design: Patients can wake, follow commands and keep breathing on their own while it runs. That is why the infusion can continue through extubation. Waking to stimulation is not failure. Reassess before you escalate.
Not for Deep Sedation or RSI: Deep sedation is not its job. At labeled doses it gives light, arousable sedation. During neuromuscular blockade, severe ventilator dyssynchrony or a deep sedation order, use propofol or another agent. In SPICE III, 64% of patients given dexmedetomidine needed supplemental propofol in the first 2 days to reach the sedation target. It is not an induction or RSI agent. Onset is 15–20 min after a 10-min load.
Alcohol Withdrawal Trap: It calms the autonomic storm, but withdrawal keeps marching on. With no GABA activity, it has no brake on the withdrawal itself. Treat that with a benzodiazepine or phenobarbital. Dexmedetomidine stays an adjunct.
Bradycardia: Check Perfusion First: Heart rate in the low 50s with a good MAP and clear mentation? Often a lower rate is all it needs. Bradycardia with hypotension or pauses? Stop the infusion, then reach for atropine or glycopyrrolate.
Exam Discriminator: Which ICU Sedative?:
- Dexmedetomidine: α2 agonist, arousable, minimal respiratory depression, bradycardia and hypotension
- Propofol: GABA, deep sedation possible, hypotension, apnea, PRIS
- Midazolam: GABA, accumulates, more delirium. PADIS prefers propofol or dexmedetomidine over benzodiazepines
Pharmacology
Mechanism of Action
- Highly selective α2-adrenergic agonist (α2:α1 about 1,620:1). Less norepinephrine is released from the locus coeruleus. The result is sedation that resembles natural sleep, with arousability.
- Spinal α2 receptors give an analgesic, opioid-sparing effect.
- Central sympatholysis lowers HR and BP. High peak levels (bolus, fast load) stimulate vascular α2 receptors, causing transient hypertension with reflex bradycardia.
- No GABA activity, so respiratory depression stays minimal at labeled doses.
Pharmacokinetics
| Route | Onset | Peak | Duration |
|---|---|---|---|
| IV (1 mcg/kg over 10 min) | 15–20 min; without a load, builds over hours | — | Offset depends on infusion length; T½ about 2 hr |
| IN (off-label) | 15–45 min | Plasma peak about 38 min | 1–2 hr |
| SL / Buccal (Igalmi) | 20–30 min | Plasma peak about 2 hr | Studied to 2 hr; T½ about 2.8 hr |
- Half-life: distribution about 6 min; terminal about 2 hr (2.2–3.7 hr in ICU patients); longer in hepatic impairment.
- Metabolism: near-complete hepatic: direct N-glucuronidation, CYP2A6 hydroxylation and N-methylation.
- Active metabolites: none clinically relevant.
- Elimination: 95% in urine as metabolites, 4% in feces; no unchanged drug in urine.
- Protein binding / Vd: 94% bound; Vss about 118 L; bioavailability about 65–82% IN (65% non-compartmental, 82% population-PK model), 72% SL, 82% buccal, 16% oral.
Names & Classification
- Generic Name
- Dexmedetomidine hydrochloride
- Brand Names
- Precedex (IV); Igalmi (sublingual film); generics. International: Dexdor.
- Pharmacologic Class
- Selective α2-adrenergic agonist (imidazole derivative)
- Therapeutic Class
- Sedative; analgesic adjunct
- Controlled Substance
- Not controlled
- ISMP High-Alert
- Yes: ISMP high-alert medication (moderate sedation agents, IV)
- Look-Alike / Sound-Alike
- dexmedeTOMIDine / dexAMETHasone (ISMP List of Confused Drug Names); also check the 100 mcg/mL concentrate against the 4 mcg/mL premix
References
- Hospira, Inc. (2026). PRECEDEX (dexmedetomidine hydrochloride) injection, for intravenous use: Full prescribing information (revised 05/2026). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=548a88c0-afda-427e-75ac-5af0cfa2224c
- BioXcel Therapeutics. (2025). IGALMI (dexmedetomidine) sublingual film: Full prescribing information (revised 11/2025). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99476e8c-2527-4cb0-9d67-9f9cd91343c6
- Lewis, K., Balas, M. C., Stollings, J. L., McNett, M., Girard, T. D., Chanques, G., Kho, M. E., Pandharipande, P. P., et al. (2025). A focused update to the clinical practice guidelines for the prevention and management of pain, anxiety, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 53(3), e711–e727. https://doi.org/10.1097/CCM.0000000000006574
- Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., et al. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU (PADIS). Critical Care Medicine, 46(9), e825–e873. https://doi.org/10.1097/CCM.0000000000003299
- Walsh, T. S., Parker, R. A., Aitken, L. M., McKenzie, C. A., Emerson, L., Boyd, J., Macdonald, A., Beveridge, G., et al., for the A2B Trial Investigators. (2025). Dexmedetomidine- or clonidine-based sedation compared with propofol in critically ill patients: The A2B randomized clinical trial. JAMA, 334(1), 32–45. https://doi.org/10.1001/jama.2025.7200
- Smith, H. A. B., Besunder, J. B., Betters, K. A., Johnson, P. N., Srinivasan, V., Stormorken, A., Farrington, E., Golianu, B., et al. (2022). 2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatric Critical Care Medicine, 23(2), e74–e110. https://doi.org/10.1097/PCC.0000000000002873
- Weerink, M. A. S., Struys, M. M. R. F., Hannivoort, L. N., Barends, C. R. M., Absalom, A. R., & Colin, P. (2017). Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clinical Pharmacokinetics, 56(8), 893–913. https://doi.org/10.1007/s40262-017-0507-7
- Rocha, K. O., Santos, E. R. F. A., Pombeiro, M. M., Fidelis, M. N. D. S. L., Kakehasi, F. M., & Teixeira, D. C. (2026). Intranasal dexmedetomidine for procedural sedation in children: A systematic review and meta-analysis. Brazilian Journal of Anesthesiology, 76(1), 844717. https://doi.org/10.1016/j.bjane.2025.844717
- Shehabi, Y., Howe, B. D., Bellomo, R., Arabi, Y. M., Bailey, M., Bass, F. E., Bin Kadiman, S., McArthur, C. J., Murray, L., Reade, M. C., Seppelt, I. M., Takala, J., Wise, M. P., Webb, S. A., & ANZICS Clinical Trials Group and the SPICE III Investigators. (2019). Early sedation with dexmedetomidine in critically ill patients. New England Journal of Medicine, 380(26), 2506–2517. https://doi.org/10.1056/NEJMoa1904710
- Institute for Safe Medication Practices (ISMP). (2024). ISMP List of High-Alert Medications in Acute Care Settings (lists moderate sedation agents, IV, including dexmedetomidine). https://www.ismp.org/system/files/resources/2024-01/ISMP_HighAlert_AcuteCare_List_010924_MS5760.pdf
- Institute for Safe Medication Practices (ISMP). (2024). ISMP List of Confused Drug Names (updated through June 2024; dexAMETHasone / dexmedeTOMIDine). https://online.ecri.org/hubfs/ISMP/Resources/ISMP_ConfusedDrugNames.pdf
- American Heart Association. (2025). 2025 AHA Guidelines for CPR and ECC, Part 8: Pediatric advanced life support, including the PALS bradycardia algorithm (start CPR for heart rate under 60/min with cardiopulmonary compromise). https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/pediatric-advanced-life-support
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