Dexmedetomidine

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Dexmedetomidine
File:Dexmedetomidine skeletal.svg
Systematic (IUPAC) name
(S)-4-[1-(2,3-dimethylphenyl)ethyl]-3H-imidazole
Clinical data
Routes of
administration		 by intravenous infusion only
Pharmacokinetic data
Protein binding 94%
Metabolism near complete hepatic metabolism to inactive metabolites
Biological half-life 2 hours
Excretion urinary
Identifiers
CAS Number 113775-47-6
ATC code N05CM18 (WHO)
PubChem CID 68602
DrugBank APRD00578
ChemSpider 4470605
Chemical data
Formula C13H16N2
Molar mass 200.28 g/mol[[Script error: No such module "String".]]
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Dexmedetomidine is a sedative medication used by intensive care units and anesthesiologists, and is marketed under the brand name Precedex (Hospira, Inc.) in the United States. It is relatively unique in its ability to provide sedation without causing respiratory depression. Like clonidine, its mechanism of action is agonism of alpha-2 adrenergic receptors in certain parts of the brain.[1]

Description

Clinical pharmacology

Indications

Dexmedetomidine is indicated for sedation of critically ill or injured patients in an intensive care unit setting. 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.

Intensive care unit sedation

Compared to midazolam, dexmedetomidine was similarly effective for sedation, but shortened the time to extubation, was associated with less delirium, and experience more bradycardia and less tachycardia and hypertension.[3] It also seemed to be superior to lorazepam for ventilated patients in the intensive care unit.[4] Compared to midazolam, dexmedetomidine is superior due to reduced intensive care costs. The reduced decreased costs are due to a reduction in intensive care unit stay costs as well as reduced mechanical ventilation costs.[5]

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.[6]

Other

Dexmedetomidine may be useful for the treatment of the deleterious cardiovascular effects of acute cocaine intoxication and overdose.[7]

Dosage and administration

Warnings, precautions, and adverse effects

Drug interactions

See also

References

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External links

Precedex Website

GABAA receptor
Ultrashort-acting
Short/intermediate-
acting
Long-acting
Ungrouped
Short-acting
Intermediate-acting
Long-acting
Dialkylphenols
Alpha-2 adrenergic
receptor
4-NEMD • Clonidine • Dexmedetomidine • Lofexidine • Medetomidine • Romifidine • Tizanidine • Xylazine
Melatonin receptor
Histamine receptor &
Acetylcholine receptor
5-HT2A &
α1-adrenergic
Selective 5-HT2A & α1-adrenergic antagonists
GABAB receptor /
GHB receptor
GHB Type
Orexin receptors
Orexin antagonists
Other receptors/
ungrouped
Other

M: PSO/PSI

dsrd (o, p, m, p, a, d, s), sysi/epon, spvo

proc, drug(N5A/5B/5C/6A/6B/6D)

fr:Dexmédétomidine
  1. ↑ Cormack JR, Orme RM, Costello TG (2005). "The role of alpha2-agonists in neurosurgery". Journal of Clinical Neuroscience. 12 (4): 375–378. doi:10.1016/j.jocn.2004.06.008. PMID 15925765. 
  2. ↑ PubChem 5311068
  3. ↑ 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. 
  4. ↑ Pandharipande, PP; Pun, BT; Herr, DL; Maze, M; Girard, TD; Miller, RR; Shintani, AK; Thompson, JL; Jackson, JC (2007). "Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial". JAMA : the journal of the American Medical Association. 298 (22): 2644–53. doi:10.1001/jama.298.22.2644. PMID 18073360. 
  5. ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
  6. ↑ Paris A, Tonner PH (2005). "Dexmedetomidine in anaesthesia". Current Opinion in Anaesthesiology. 18 (4): 412–418. doi:10.1097/01.aco.0000174958.05383.d5. PMID 16534267. 
  7. ↑ 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. 
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