Dexmedetomidine INTRAVENOUS for Adults

admin — Wed, 20 Feb 2013 08:20:35 +0000

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

Doses in excess of the licensed maximum of 1.4microgram/kg/hour must also be authorised by consultant.
AVOID a loading dose in ICU sedation (increased adverse reactions)
The RCT SPICE III (ventilated adult ICU patients) found an increased risk of mortality with dexmedetomidine in those aged 65 years or younger compared to usual standard of care.
There is no experience with use of this drug for longer than 14 days
Contraindicated: acute cerebrovascular conditions, heart-block Grade II or III unless paced. See SPC for full list of contraindications
Withdrawal symptoms (e.g., hypertension, tachycardia, delirium, agitation) may be more likely to occur in patients with a history of hypertension or those receiving drug for longer durations, with greater cumulative daily doses (e.g. >0.5mcg/kg/hr). In such patients, avoid abrupt discontinuation^{(ref 2)}
For Y-site compatibility see below

Available preparations

Dexmedetomidine (EVER) 1000 micrograms/10mLvial (for use in Critical Care only)
Dexmedetomidine (EVER) 200 micrograms/2mL (for use in Theatres only)

Reconstitution

Already in solution

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

Critical care

Add 5mL (500 micrograms) to 45mL of diluent (final concentration of 10micrograms/ml) ^{(ref 1)}

Theatres

Add 2mL (200 micrograms) to 48mL of diluent (final concentration of 4micrograms/ml)

Concentrations above 4microgram/ml: administer via a large vein or preferably through a dedicated port of a central line ^{(ref 1)}

Dose in adults

A: Critical care

A1. Starting dose

0.7microgram/kg/hour - but frail patients may require lower starting doses

A2. Maintenance dose

Normally 0.2 to 1.4microgram/kg/hour
After dose adjustment, a new steady state sedation level may not be reached for up to one hour

Critical care ONLY: Dexmedetomidine 500microgram in 50ml: flow rates in ml/hour
Dose (micrograms/kg/hour)	0.2	0.3	0.4	0.5	0.6	0.7	0.8	0.9	1	1.1	1.2	1.3	1.4
Weight (kg)
35kg	0.7	1.1	1.4	1.8	2.1	2.5	2.8	3.2	3.5	3.9	4.2	4.6	4.9
40kg	0.8	1.2	1.6	2	2.4	2.8	3.2	3.6	4	4.4	4.8	5.2	5.6
45kg	0.9	1.4	1.8	2.3	2.7	3.2	3.6	4.1	4.5	5	5.4	5.9	6.3
50kg	1	1.5	2	2.5	3	3.5	4	4.5	5	5.5	6	6.5	7
55kg	1.1	1.7	2.2	2.8	3.3	3.9	4.4	5	5.5	6.1	6.6	7.2	7.7
60kg	1.2	1.8	2.4	3	3.6	4.2	4.8	5.4	6	6.6	7.2	7.8	8.4
65kg	1.3	2	2.6	3.3	3.9	4.6	5.2	5.9	6.5	7.2	7.8	8.5	9.1
70kg	1.4	2.1	2.8	3.5	4.2	4.9	5.6	6.3	7	7.7	8.4	9.1	9.8
75kg	1.5	2.3	3	3.8	4.5	5.3	6	6.8	7.5	8.3	9	9.8	10.5
80kg	1.6	2.4	3.2	4	4.8	5.6	6.4	7.2	8	8.8	9.6	10.4	11.2
85kg	1.7	2.6	3.4	4.3	5.1	6	6.8	7.7	8.5	9.4	10.2	11.1	11.9
90kg	1.8	2.7	3.6	4.5	5.4	6.3	7.2	8.1	9	9.9	10.8	11.7	12.6
95kg	1.9	2.9	3.8	4.8	5.7	6.7	7.6	8.6	9.5	10.5	11.4	12.4	13.3
100kg	2	3	4	5	6	7	8	9	10	11	12	13	14
105kg	2.1	3.2	4.2	5.3	6.3	7.4	8.4	9.5	10.5	11.6	12.6	13.7	14.7
110kg	2.2	3.3	4.4	5.5	6.6	7.7	8.8	9.9	11	12.1	13.2	14.3	15.4
115kg	2.3	3.5	4.6	5.8	6.9	8.1	9.2	10.4	11.5	12.7	13.8	15	16.1
120kg	2.4	3.6	4.8	6	7.2	8.4	9.6	10.8	12	13.2	14.4	15.6	16.8

B. Theatres

B1. Initiation of procedural/awake sedation

Give a loading infusion of 1microgram/kg over 10 minutes
For less invasive procedures e.g. ophthalmic surgery give 0.5 micrograms/kg over 10 minutes

B2. Maintenance of procedural/awake sedation

The maintenance infusion is usually started at 0.6 microgram/kg/hour
Titrate to desired clinical effect with doses ranging from 0.2 to 1 microgram/kg/hour
Adjust the rate of the maintenance infusion to achieve the targeted level of sedation

Theatre USE ONLY: Dexmedetomidine 200microgram in 50ml: flow rates in ml/hour
Dose (micrograms/kg/hour)	Initial maintenance dose (0.6mcg/kg/hour)	Lower end of dosing range (0.2mcg/kg/hour)	Higher end of dosing range (1 mcg/kg/hour)
Weight (kg)
30kg	4.5	1.5	7.5
40kg	6	2	10
50kg	7.5	2.5	12.5
60kg	9	3	15
70kg	10.5	3.5	17.5
80kg	12	4	20
90kg	13.5	4.5	22.5
100kg	15	5	25
110kg	16.5	5.5	27.5
120kg	18	6	30

Hepatic impairment

Use with caution. Lower doses may be required

Monitoring

Specialist monitoring required
If concentrations above 4microgram/ml are being used, monitor the area distal to the infusion for evidence of irritation ^{(ref 1)}

Further information

An unlicensed concentration of 10microgram/ml is being used on the intensive care unit for safety and pharmacoeconomic reasons. Evidence supporting this higher concentration is limited ^{(ref 1)}

Storage

Store below 25⁰C

References

SPC Dexmedetomidine (EVER) Pharma 100mcg/ml concentrate 24/07/2023

An unlicensed concentration of 10 microgram/mL is being used in critical care. Its use is based on local practice and perceived safety and pharmacoeconomic benefits; however, evidence supporting this higher concentration is limited. "Infusion concentration information". Emails on file
UpToDate, accessed online 06/08/2026
Written communication from Dr Patrick Neligan Jan 21 2015 and November 7 2018

Therapeutic classification

Selective alpha-2 receptor agonist

BNF

CNS

IV Guide Type

Critical care

Droperidol Intravenous for Adults

admin — Tue, 24 Apr 2012 09:48:54 +0000

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

Contraindicated in patients with known or suspected prolonged QT interval
Avoid use with medications which also cause QTc prolongation
Cardiovascular monitoring required (see monitoring requirements below)

Available preparations

Droperidol (Panpharma) 2.5mg per 1mL ampoule (unlicensed)

Reconstitution

Already in solution

Draw up using a 5 micron filter needle

Methods of intravenous administration

Slow intravenous injection

Administer over at least 3 minutes ^{(ref 1)}

Dose in adults

Prevention and treatment of post-operative nausea and vomiting (PONV)

Adults: 0.625 to 1.25mg (see also further information)
Elderly: maximum 0.625mg
May be repeated every six hours as required
Renal/hepatic impairment: maximum 0.625mg (caution advised in renal and hepatic impairment)
Administration of droperidol is recommended 30 minutes before the anticipated end of surgery

Monitoring

Continuous pulse oximetry should be performed in patients with known or suspected risk of ventricular arrhythmia and should continue for 30 minutes following single intravenous administration^{(ref 1)}
ECG monitoring if cardiovascular risk factors^{(ref 1)}
Monitor blood pressure and heart rate^{(ref 1)}

Further information

The manufacturers suggest that droperidol may be added to PCA. However, this is not practice within GUH. See SPC for further details

Storage

Store below 25⁰C

References

Droperidol (Aguettant) downloaded March 2025

1: Medusa http://medusa.wales.nhs.uk/ accessed online 23rd Feb 2023

Therapeutic classification

Anti-emetic, Butyrophenone neuroleptic

BNF

CNS