Section 13 · Monograph
Dexmedetomidine
Reviewed Nov 2026FDA label
PrecedexAlpha-2 agonist sedative
- Forms
- IV: 4mcg/mL premixed (80mcg/20mL, 200mcg/50mL, 400mcg/100mL) | Concentrate: 100mcg/mL
- Dose
- ICU sedation: optional 1mcg/kg load over 10 min, then 0.2-0.7mcg/kg/h (up to 1.5mcg/kg/h)
- MOA
- Selective central α2 agonism; sedation with minimal respiratory depression
Indications
- Sedation of initially intubated and mechanically ventilated patients in an ICU settingFDA-labeled
- Procedural sedation of non-intubated patientsFDA-labeled
Off-Label Uses
- Agitation and delirium in neurocritical careOff-label
- Withdrawal-related agitationOff-label
Mechanism of Action
- Highly selective alpha-2 adrenergic agonist producing sedation, anxiolysis and analgesia with minimal respiratory depression
Full Dosing
Adult / usual
- ICU sedation: optional loading dose 1mcg/kg over 10 minutes (often omitted to reduce hemodynamic effects), then 0.2-0.7mcg/kg/h; may titrate up to 1.5mcg/kg/h
- Label limits ICU sedation to 24 hours (longer use common in practice)
Hepatic
- Reduce dose in hepatic impairment and in older patients
Contraindications
- Known hypersensitivity to dexmedetomidine
Drug Interactions
- Additive sedative effects with anesthetics, opioids and benzodiazepines
- Additive hypotension and bradycardia with beta-blockers and other negative chronotropes
Adverse Effects
- Bradycardia and hypotension
- Transient hypertension with loading dose
- Dry mouth, nausea
- Withdrawal-like symptoms after prolonged infusion
- Fever (dexmedetomidine-associated)
Monitoring Parameters
- Continuous ECG and blood pressure
- Sedation level
- Heart rate and rhythm, especially with loading doses
Pregnancy & Lactation
- Limited data; use if benefit justifies risk
- Excreted in milk in small amounts