Detomax IV

Indications

Dexmedetomidine is a sedative used in hospital. It is used to calm and sedate adults who are on breathing machines or otherwise need sedation in the intensive care unit (ICU), and to provide light to moderate sedation during surgery and procedures (for example, endoscopy or awake procedures) while the patient can still be roused and can breathe on their own.

How It Works

Dexmedetomidine stimulates alpha-2 receptors in the brain, especially in an area called the locus coeruleus, which controls alertness. This reduces the release of noradrenaline, producing a calm, sleep-like state that resembles natural sleep. It also has some pain-relieving effect and reduces anxiety, while causing little depression of breathing.

Dosage and Administration

Dexmedetomidine is given only by trained doctors or nurses, usually anaesthetists or ICU staff, as a continuous infusion into a vein using a pump. The dose is adjusted for each patient according to body weight, the level of sedation needed, age and liver function. Heart rate, blood pressure, breathing and oxygen levels are monitored continuously during use.

Interactions

• Other sedatives, anaesthetics, opioid painkillers, and sleeping or anti-anxiety medicines increase its effect, so their doses may need to be lowered.
• Medicines that slow the heart or lower blood pressure, such as beta blockers or some calcium channel blockers, can add to slow heart rate and low blood pressure.

Contraindications

• Allergy to Dexmedetomidine or any ingredient.
• Advanced heart block without a pacemaker.
• Uncontrolled low blood pressure.
• Acute stroke or similar brain blood flow problems (for some products).

Side Effects

The most common side effects are a slow heart rate, low blood pressure, high blood pressure (especially at the start), nausea, dry mouth and low oxygen levels. Rarely, it can cause heart rhythm problems or heart stopping. After long use, stopping suddenly can cause agitation, rapid heartbeat and raised blood pressure.

Since it is given in a monitored setting, staff will act on any problem straight away. Tell staff urgently if the patient has chest pain, severe dizziness, difficulty breathing or confusion after the infusion stops.

Pregnancy and Lactation

There is limited information in pregnancy; it is used only if the doctor decides the benefit outweighs the risk. Small amounts may pass into breast milk; the doctor will advise on when breastfeeding can safely resume after treatment.

Precautions and Warnings

• Used only where full monitoring and resuscitation equipment are available.
• Extra care is needed in elderly people, people with heart disease, low blood volume, diabetes, liver impairment or spinal cord injury.
• Prolonged infusions are reduced gradually rather than stopped suddenly.
• The patient should not drive or make important decisions until fully recovered.

Overdose

Overdose can cause very slow heart rate, low blood pressure, heavy sedation and, rarely, heart stopping. The infusion is stopped and treatment is given by the medical team.

Therapeutic Class

Sedative, selective alpha-2 adrenergic agonist.

Storage

Store as directed on the pack, usually below 30°C and out of the reach of children. Diluted solutions should be used within the time stated by the manufacturer.