Pharmacology Corner Journal of Addictions Nursing & Volume 24 & Number 2, 122 & Copyright B 2013 International Nurses Society on Addictions

Editor: Albert Anthony Rundio, PhD, DNP, RN, APRN, CARN-AP, NEA-BC

Dexmedetomidine ‘‘Precedex’’ Dexmedetomidine hydrochloride (Precedex) is a potent alpha2-adrenoceptor agonist. This medication has an eight times higher affinity for the alpha2-adrenoceptor than clonidine (Catapres). Dexmedetomidine has shown sedative, analgesic, and anxiolytic effects after intravenous administration to healthy volunteers or postsurgical patients in the intensive care unit. The primary use of dexmedetomidine is for maintaining intubated patients in an intensive care setting and also for surgical procedures as well as other procedures that require sedation. New research is demonstrating that dexmedetomidine may be an effective treatment for patients hospitalized in an intensive care setting who are in acute alcohol withdrawal states where standard therapy with other benzodiazepines has not been effective. Rayner, Weiner, Peng, Jepssen, and Broccard (2012) conducted an observational study that reviewed patient records from a 23-bed mixed medicalYsurgical intensive care unit in Minnesota. Records were abstracted from November 2008 to November 2010, a 2-year time period. The primary analysis was a comparison of alcohol withdrawal severity scales and medication dosing for 24 hours before dexmedetomidine therapy being initiated to values obtained during the first 24-hour time period after initiation of dexmedetomidine therapy. Rayner et al. (2012) reported that there was a 61.5% reduction in benzodiazepine dosing after dexmedetomidine therapy had been initiated. There was a marked reduction in the alcohol withdrawal severity scores noted. Benefits of this therapy indicated that patients experienced less tachycardia and hypertension, which are classic symptoms of acute alcohol withdrawal syndromes. It should be noted that, in this study, there was a low rate of mechanical ventilation in the patients receiving dexmedetomidine therapy. The authors concluded that prospective clinical trials for patients admitted to the intensive care unit in acute alcohol withdrawal syndromes refractory to conventional benzodiazepine therapy need to be conducted. DOSAGE A loading infusion of up to 1 mcg/kg administered over 10 minutes is the usual loading infusion. Drexel University College of Nursing & Health Professions, Philadelphia, Pennsylvania. The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article. Correspondence related to content to: Albert Anthony Rundio, PhD, DNP, RN, APRN, CARN-AP, NEA-BC, Drexel University College of Nursing & Health Professions, 1505 Race Street, Room 429, Philadelphia PA 19102. E-mail: [email protected] DOI: 10.1097/JAN.0b013e3182929764 122

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Dose reductions need to be considered in patients over the age of 65 years and those with hepatic impairment. The standard maintenance infusion rate is 0.2Y0.7 mcg/kg/hr. The rate of maintenance infusions need to be titrated to the desired level of sedation for the patient (nih.gov). Dosage Forms and Strengths 200 mcg/2 mL (100 mcg/mL) in a glass vial. Vials are for single use only. CONTRAINDICATIONS & Dexmedetomidine hydrochloride should not be administered to patients under the age of 18 years as this medication has not been evaluated clinically in such patients. & Dexmedetomidine hydrochloride should not be administered to pregnant patients. This medication is listed as Pregnancy Category C. & Dexmedetomidine hydrochloride should not be administered to pregnant patients in labor. & Dexmedetomidine hydrochloride should not be administered to women who are breast feeding. Clinical trials have not been conducted in this population. USE CAUTIOUSLY Dexmedetomidine should be used cautiously in the following patients: & Patients with hepatic failure & Older adults, especially those patients above the age of 75 years & Patients with a history of bradydysrhythmia inclusive of both partial and complete heart blocks, and patients with intermittent periods of sinus arrest SIDE EFFECTS The most common side effects reported have been the following: & hypotension & bradycardia & periods of sinus arrest & dry mouth Note: Dexmedetomidine must be administered by anesthesiologists/nurse anesthetists. Appropriate intubation equipment must be immediately available. Patients must have continuous cardiac monitoring and continuous waveform capnography. REFERENCE Rayner, S. G., Weiner, C. R., Peng, H., Jepsen, S., & Broccard, A. (2012). Dexmedetomidine as adjunct treatment for severe alcohol withdrawal in the ICU. Annals of Intensive Care, 2(1), 12. doi:10.1186/ 2110-5820-2-12 April/June 2013

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