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Alpha-2 Agonist Sedative / Analgesic Pregnancy: Avoid in pregnancy — limited data; uterine vasoconstriction possible

Dexmedetomidine

Brand names: Dexdor, Precedex

Adult dose

Dose: 0.2-1.4 micrograms/kg/hr IV infusion (ICU sedation); 0.5-1 microgram/kg IV over 10 min (procedural)
Route: Intravenous infusion
Frequency: Continuous infusion (ICU); loading dose then infusion (procedural)
Max: 1.4 micrograms/kg/hr
NICE-approved for ICU sedation in intubated adults requiring sedation depth no deeper than awakening (RASS 0 to -3). Unique: preserves arousability and natural sleep architecture

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: IV
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion — not licensed in children; used off-label in paediatric ICU

Dose adjustments

Renal

No dose adjustment required

Hepatic

Consider dose reduction in severe hepatic impairment — hepatically metabolised

Paediatric weight-based calculator

Seek specialist opinion — not licensed in children; used off-label in paediatric ICU

Clinical pearls

  • Cooperative sedation: dexmedetomidine allows patients to be sedated yet rousable and communicating — ideal for procedures requiring patient cooperation (awake fibreoptic intubation, awake craniotomy) and light ICU sedation
  • Opioid-sparing: significantly reduces opioid consumption — useful in opioid-tolerant patients and for enhanced recovery protocols
  • Transient hypertension during loading dose: peripheral alpha-2B receptor stimulation causes vasoconstriction before the central sympatholytic effect predominates — give loading dose slowly or omit in haemodynamically unstable patients
  • No respiratory depression at clinical doses — maintains spontaneous ventilation; unique among sedative agents
  • MENDS2 trial: dexmedetomidine vs propofol for ICU sedation — similar outcomes; dexmedetomidine associated with more bradycardia but less delirium

Contraindications

  • Advanced heart block (without pacemaker)
  • Severe bradycardia
  • Uncontrolled hypotension

Side effects

  • Bradycardia (most common — dose-dependent)
  • Hypotension
  • Dry mouth
  • Nausea
  • Agitation (paradoxical)
  • Hypertension (transient with loading dose — alpha-2A peripheral vasoconstriction before central effect)

Interactions

  • Antihypertensives (additive hypotension)
  • Opioids and benzodiazepines (dose-sparing — can significantly reduce requirements)
  • Beta-blockers (additive bradycardia)

Monitoring

  • Heart rate (bradycardia)
  • Blood pressure
  • RASS sedation score
  • Respiratory rate and SpO2

Reference: BNFc; BNF 90; Dexdor SPC; NICE TA654; MENDS2 Trial; PRODEX Trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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