Dexmedetomidine (Precedex)


Cocaine Intoxication (see Cocaine)

Clinical Efficacy

  • Dexmedetomidine is Effective in Treatment of the Cardiovascular Effects of Cocaine Intoxication (J Am Coll Cardiol, 2007) [MEDLINE]

Alcohol (Ethanol) Withdrawal (see Ethanol)

Clinical Efficacy

  • Dexmedetomidine Decreases Benzodiazepine Dosing, Decreases Alcohol Withdrawal Scoring, and Blunts Hyperadrenergic Cardiovascular Responses (Ann Intensive Care, 2012) [MEDLINE]
    • Dexmedetomidine Can Be Used as an Adjunct to Benzodiazepines
  • Prospective Randomized Trial of Dexmedetomidine as Add-On Therapy to Lorazepam in Severe Alcohol Withdrawal (Crit Care Med, 2014) [MEDLINE]
    • Adjunctive Dexmedetomidine Maintains Symptom Control in Severe Alcohol Withdrawal, Decreasing Short-Term (But Not Long-Term) Lorazepam Use When Using a Symptom-Triggered Protocol
    • Monitoring for Bradycardia is Required with Dexmedetomidine and is Less Significant with Lower Infusion Rates
  • Retrospective Cohort Study of Dexmedetomidine vs Benzodiazepines in Alcohol Withdrawal (Pharmacotherapy, 2014) [MEDLINE]
    • Adjunctive Dexmedetomidine Manifested a Benzodiazepine-Sparing Effect in Alcohol Withdrawal
    • Although the Total Cost of Hospitalization was Similar Between the Groups, Dexmedetomidine was Associated with a Higher Study Drug Cost Per Patient

Cancer-Related Intractable Pain/Agitation/Delirium (J Pain Palliative Care Pharmacotherapy, 2006) [MEDLINE]

Clinical Efficacy

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Post-Renal Transplant (see Renal Transplant)

Clinical Efficacy

  • Trial of Dexmedetomidine Post-Renal Transplant (JAMA Netw Open. Published online June 3, 2022. doi:10.1001/jamanetworkopen.2022.15217 [MEDLINE]
    • 24-hour Perioperative Dexmedetomidine Decreased the Incidence of Delayed Graft Function After Donation-After-Cardiac-Death Renal Transplant

Procedural Sedation (see Sedation)

  • Bone Marrow Biopsy (see Bone Marrow Biopsy)
  • Bronchoscopy (see Bronchoscopy)
  • Endoscopy
  • Fine Needle Aspiration (FNA) of Mass/Lesion
  • Foreign Body Extraction: particularly in pediatric populations
  • Surgery
    • Dexmedetomidine Decreases Inhalational Anesthetic, Sedative, and Analgesic Requirements

Sedation in the Intensive Care Unit (ICU) (see Sedation)


  • Need for Sedation While Intubated on Invasive Mechanical Ventilation
  • Due to a Lack of Respiratory Depression, Dexmedetomidine May Also Be Used in the Setting of Ventilator Weaning and Extubation (see Invasive Mechanical Ventilation-Weaning)

Clinical Efficacy

  • Dexmedetomidine to Lessen ICU Agitation (DahLIA) Trial: Comparison of Dexmedetomidine to Placebo in Agitated Delirium in Mechanically-Ventilated Patients in the Intensive Care Unit (JAMA, 2016) [MEDLINE]
    • Dexmedetomidine Increased Ventilator-Free Hours at 7 Days, as Compared to Usual Care
    • Dexmedetomidine Decreased Time to Extubation and Accelerated Resolution of Delirium
  • Meta-Analysis of Dexmedetomidine in ICU Sedation (Anaesth Crit Care Pain Med, 2016)[MEDLINE]
    • Dexmedetomidine was Associated with a 48 hr Reduction in ICU Length of Stay, Mechanical Ventilation Duration, and Duration of Delirium: despite significant heterogeneity among the studies
    • Dexmedetomidine was Associated with an Increased Risk of Bradycardia and Hypotension
  • Study of Predictors of Patient Undergoing Next-Day Spontaneous Awakening Trial/Spontaneous Breathing Trial from National Quality Improvement Data (Chest, 2022) [MEDLINE]
    • Population Included Patients from 68 Intensive Care Units
      • Spontaneous Awakening Trial: n = 4,847
      • Spontaneous Breathing Trial: n = 4,936
    • Factors Associated with Higher Odds of a Next-Day Spontaneous Awakening Trial/Spontaneous Breathing Trial
      • Documented Target Sedation Level (Adjusted Odds Ratio: 1.68; 95% CI: 1.41-2.01; Adjusted Odds Ratio: 1.46; 95% CI: 1.24-1.72)
      • Dexmedetomidine Administration (Adjusted Odds Ratio: 1.23; 95% CI: 1.05-1.45; Adjusted Odds Ratio: 1.52; 95% CI: 1.27-1.80)
      • More Frequent Level of Arousal Assessments (Adjusted Odds Ratio: 1.22; 95% CI: 1.03-1.43; Adjusted Odds Ratio: .32; 95% CI: 1.13-1.54)
      • Physical Restraint Use (Adjusted Odds Ratio: 1.63; 95% CI: 1.42-1.87; Adjusted Odds Ratio: 1.83; 95% CI,: 1.60-2.09)
    • Factors Associated with Lower Odds of a Next-Day Spontaneous Awakening Trial/Spontaneous Breathing Trial
      • Benzodiazepine Administration (Adjusted Odds Ratio: 0.83; 95% CI: 0.72-0.95; Adjusted Odds Ratio: 0.67; 95% CI: 0.59-0.77)
      • Deep Sedation/Coma (Adjusted Odds Ratio: 0.69; 95% CI: 0.60-0.80; Adjusted Odds Ratio: 0.33; 95% CI: 0.28-0.37)
      • Ketamine Administration (Adjusted Odds Ratio: 0.34; 95% CI: 0.16-0.71; Adjusted Odds Ratio: 0.40; 95% CI: 0.18-0.88)


Dexmedetomidine is an α2-Adrenergic Receptor Agonist (see α2-Adrenergic Receptor Agonists)

Protein Binding




Intravenous (Maintenance for Sedation in the Intensive Care Unit) (see Sedation)

Dose Adjustment

Adverse Effects

Cardiovascular Adverse Effects

Gastrointestinal Adverse Effects

Other Adverse Effects

Dry Mouth (Xerostomia) (see Xerostomia)

Dexmedetomidine Withdrawal Syndrome

Risk Factors

  • Continuous Dexmedetomidine Infusion for a Longer Duration
  • Higher Cumulative Daily Dexmedetomidine Dose (>12 mcg/kg/Day)
  • Higher Peak Dexmedetomidine Rate (>0.8 mcg/kg/hr)
  • History of Hypertension (see Hypertension)

Clinical Manifestations


  • In Patients at Risk, Avoid Abrupt Dexmedetomidine Discontinuation and Wean Slowly While Monitoring for Withdrawal Symptoms (Crit Care Explor, 2019) [MEDLINE] (Pharmacotherapy, 2019) [MEDLINE] (J Crit Care, 2020) [MEDLINE]


Indications-Alcohol Withdrawal

Indications-Intensive Care Unit Sedation (see Sedation)

Indications-Post-Renal Transplant (see Renal Transplant)


Adverse Effects