Precedex, (dexmedetomidine) dosing, indications, interactions ...

Medscape - Indication-specific dosing for Precedex, (dexmedetomidine), frequency-based adverse effects, comprehensive interactions, contraindications, ... ForYou News&Perspective Drugs&Diseases CME&Education Academy Video DecisionPoint Edition: ENGLISH DEUTSCH ESPAÑOL FRANÇAIS PORTUGUÊS LogIn SignUpIt'sFree! Edition: ENGLISH DEUTSCH ESPAÑOL FRANÇAIS PORTUGUÊS Register LogIn NoResults NoResults ForYou News&Perspective Drugs&Diseases CME&Education Academy Video DecisionPoint close PleaseconfirmthatyouwouldliketologoutofMedscape. Ifyoulogout,youwillberequiredtoenteryourusernameandpasswordthenexttimeyouvisit. Logout Cancel https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2RydWcvcHJlY2VkZXgtZGV4bWVkZXRvbWlkaW5lLTM0MjkzMg== processing.... Drugs&Diseasesdexmedetomidine(Rx)BrandandOtherNames:PrecedexClasses:SedativesShareEmailPrintFeedbackCloseFacebookTwitterLinkedInWhatsApp SectionsSectionsdexmedetomidineDosing&UsesInteractionsAdverseEffectsWarningsPregnancyPharmacologyAdministrationImagesPatientHandoutFormularyDosing&UsesAdultPediatricGeriatricDosageForms&Strengthsinjectablesolution200mcg/2mL(100mcg/mL)single-doseglassvialRequiresfurtherdilutionbeforeadministeringready-to-useinjectablesolution80mcg/20mL0.9%NaCl(4mcg/mL)200mcg/50mL0.9%NaCl(4mcg/mL)400mcg/100mL0.9%NaCl(4mcg/mL)ICUSedationIndicatedforsedationofinitiallyintubatedandmechanicallyventilatedpatientsinICUsettingLoad:1mcg/kgIVover10minutes;loadingdosemaynotberequiredforadultsconvertedfromothersedativetherapy Maintenance0.2-0.7mcg/kg/hrcontinuousIVinfusion;nottoexceed24hrDexmedetomidinehasbeencontinuouslyinfusedinmechanicallyventilatedpatientsbefore,during,andafterextubation;itisnotnecessarytodiscontinuedexmedetomidinebeforeextubationProceduralSedationIndicatedforsedationofnonintubatedpatientsbeforeand/orduringsurgicalandotherproceduresLoad:1mcg/kgIVover10minutesMaintenance0.6mcg/kg/hrIVtitratetoeffect(usually0.2-1mcg/kg/hr) AwakefiberopticIntubationLoad:1mcg/kgIVover10minutes Maintenance0.7mcg/kg/hrIVuntilendotrachealtubesecuredDosageModificationsDosereductionmayberequiredifcoadministeredwithotherconcomitantanesthetics,sedatives,hypnotics,oropioidsConsiderdosereductioninpatientswithhepaticimpairmentoraged≥65yr;clearancedecreaseswithincreasingseverityofhepaticimpairmentRenalimpairment:NodosageadjustmentrequiredSafetyandefficacynotestablishedICUSedationIndicatedforsedationofinitiallyintubatedandmechanicallyventilatedpatientsinICUsetting;nottoexceed24hrConsiderdosereduction:Higherincidenceofbradycardiaandhypotensionwasobservedfollowingadministrationinpatientsaged>65yrDexmedetomidinehasbeencontinuouslyinfusedinmechanicallyventilatedpatientsbefore,during,andafterextubation;itisnotnecessarytodiscontinuedexmedetomidinebeforeextubationProceduralsedationIndicatedforsedationofnonintubatedpatientsbeforeand/orduringsurgicalandotherproceduresReducedloadingdoserecommended:0.5mcg/kgIVover10minutes Maintenance:ConsiderreducedmaintenanceinfusionNext:InteractionsInteractionCheckerEnteradrugnameanddexmedetomidineNoResults  NoInteractionsFoundInteractionsFoundContraindicatedSerious-UseAlternativeSignificant-MonitorCloselyMinorAllInteractionsSortBy:SeverityName  Contraindicated(1)eliglustatdexmedetomidineincreaseslevelsofeliglustatbyaffectinghepaticenzymeCYP2D6metabolism.Contraindicated.IfcoadministeredwithstrongormoderateCYP2D6inhibitors,reduceeliglustatdosefrom84mgBIDto84mgoncedailyinextensiveandintermediatemetabolizers;eliglustatiscontraindiatedifstrongormoderateCYP2D6inhibitorsaregivenconcomitantlywithstrongormoderateCYP3Ainhibitors.Serious-UseAlternative(9)calcium/magnesium/potassium/sodiumoxybatesdexmedetomidine,calcium/magnesium/potassium/sodiumoxybates. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Profoundsedation,respiratorydepression,coma,anddeathmayresultifcoadministered.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.hydrocodonehydrocodone,dexmedetomidine. Eitherincreasestoxicityoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Profoundsedation,respiratorydepression,coma,anddeathmayresultifcoadministered.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.lonafarnibdexmedetomidinewillincreasetheleveloreffectoflonafarnibbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.AvoidorUseAlternateDrug.Ifcoadministrationoflonafarnib(asensitiveCYP3Asubstrate)withweakCYP3Ainhibitorsisunavoidable,reduceto,orcontinuelonafarnibatstartingdose.Closelymonitorforarrhythmiasandevents(eg,syncope,heartpalpitations)sincelonafarnibeffectonQTintervalisunknown.metoclopramideintranasaldexmedetomidine,metoclopramideintranasal. EitherincreaseseffectsoftheotherbyOther(seecomment).AvoidorUseAlternateDrug. Comment:Avoiduseofmetoclopramideintranasalorinteractingdrug,dependingonimportanceofdrugtopatient.ponesimodponesimod,dexmedetomidine. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Consultcardiologistifconsideringtreatment.CoadministrationofponesimodwithdrugsthatdecreaseHRmayhaveadditiveeffectsondecreasingHRandshouldgenerallynotbeinitiatedinthesepatients.sodiumoxybatedexmedetomidine,sodiumoxybate. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Profoundsedation,respiratorydepression,coma,anddeathmayresultifcoadministered.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.sufentanilSLsufentanilSL,dexmedetomidine. Eitherincreasestoxicityoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Coadministrationmayresultinhypotension,profoundsedation,respiratorydepression,coma,anddeath.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.valerianvaleriananddexmedetomidinebothincreasesedation.AvoidorUseAlternateDrug.vortioxetinedexmedetomidineincreaseslevelsofvortioxetinebyaffectinghepaticenzymeCYP2D6metabolism.AvoidorUseAlternateDrug.Decreasevortioxetinedoseby50%whencoadministeredwithstrongCYP2D6inhibitors.MonitorClosely(196)albuteroldexmedetomidineincreasesandalbuteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.alfentanildexmedetomidineandalfentanilbothincreasesedation.UseCaution/Monitor.alprazolamalprazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.amitriptylinedexmedetomidineandamitriptylinebothincreasesedation.UseCaution/Monitor.amobarbitalamobarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.amoxapinedexmedetomidineandamoxapinebothincreasesedation.UseCaution/Monitor.apomorphinedexmedetomidineandapomorphinebothincreasesedation.UseCaution/Monitor.arformoteroldexmedetomidineincreasesandarformoteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.aripiprazoledexmedetomidineandaripiprazolebothincreasesedation.UseCaution/Monitor.armodafinildexmedetomidineincreasesandarmodafinildecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.atogepantdexmedetomidinewillincreasetheleveloreffectofatogepantbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.avapritinibdexmedetomidinewillincreasetheleveloreffectofavapritinibbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.axitinibdexmedetomidineincreaseslevelsofaxitinibbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.azelastineazelastineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.baclofendexmedetomidineandbaclofenbothincreasesedation.UseCaution/Monitor.belladonnaandopiumdexmedetomidineandbelladonnaandopiumbothincreasesedation.UseCaution/Monitor.benazeprildexmedetomidine,benazepril. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.UseCaution/Monitor.Increasesriskofhypotension.benperidoldexmedetomidineandbenperidolbothincreasesedation.UseCaution/Monitor.benzphetaminedexmedetomidineincreasesandbenzphetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.brexpiprazoledexmedetomidinewillincreasetheleveloreffectofbrexpiprazolebyaffectinghepaticenzymeCYP2D6metabolism.ModifyTherapy/MonitorClosely.AdministerhalfoftheusualbrexpiprazoledosewhencoadministeredwithstrongCYP2D6inhibitors.Ifalsoadministeredwithastrong/moderateCYP3A4inhibitor,administeraquarterofbrexpiprazoledose.NOTE:InMDDclinicaltrials,brexpiprazoledosagewasnotadjustedforstrongCYP2D6inhibitors(eg,paroxetine,fluoxetine);thus,CYPconsiderationsarealreadyfactoredintogeneraldosingrecommendationsandbrexpiprazolemaybeadministeredwithoutdosageadjustmentinpatientswithMDD.brompheniraminebrompheniramineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.buprenorphinedexmedetomidineandbuprenorphinebothincreasesedation.UseCaution/Monitor.buprenorphinebuccaldexmedetomidineandbuprenorphinebuccalbothincreasesedation.UseCaution/Monitor.buprenorphine,long-actinginjectiondexmedetomidineincreasestoxicityofbuprenorphine,long-actinginjectionbypharmacodynamicsynergism.ModifyTherapy/MonitorClosely.CoadministrationofbuprenorphineandbenzodiazepinesorotherCNSdepressantsincreasesriskofadversereactionsincludingoverdose,respiratorydepression,anddeath.CessationofbenzodiazepinesorotherCNSdepressantsispreferredinmostcases.Insomecases,monitoringatahigherlevelofcarefortaperingCNSdepressantsmaybeappropriate.Inothers,graduallytaperingapatientoffofaprescribedbenzodiazepineorotherCNSdepressantordecreasingtothelowesteffectivedosemaybeappropriate.butabarbitalbutabarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.butalbitalbutalbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.butorphanoldexmedetomidineandbutorphanolbothincreasesedation.UseCaution/Monitor.caffeinedexmedetomidineincreasesandcaffeinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.captoprildexmedetomidine,captopril. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.UseCaution/Monitor.Bothdrugslowerbloodpressure.Monitorbloodpressure.carbinoxaminecarbinoxamineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.carisoprodoldexmedetomidineandcarisoprodolbothincreasesedation.UseCaution/Monitor.cenobamatecenobamate,dexmedetomidine. Eitherincreaseseffectsoftheotherbysedation.UseCaution/Monitor.chloralhydratechloralhydrateanddexmedetomidinebothincreasesedation.UseCaution/Monitor.chlordiazepoxidechlordiazepoxideanddexmedetomidinebothincreasesedation.UseCaution/Monitor.chlorpheniraminechlorpheniramineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.chlorpromazinedexmedetomidineandchlorpromazinebothincreasesedation.UseCaution/Monitor.chlorzoxazonedexmedetomidineandchlorzoxazonebothincreasesedation.UseCaution/Monitor.cinnarizinecinnarizineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.clemastineclemastineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.clomipraminedexmedetomidineandclomipraminebothincreasesedation.UseCaution/Monitor.clonazepamclonazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.clorazepateclorazepateanddexmedetomidinebothincreasesedation.UseCaution/Monitor.clozapinedexmedetomidineandclozapinebothincreasesedation.UseCaution/Monitor.codeinedexmedetomidineandcodeinebothincreasesedation.UseCaution/Monitor.cyclizinecyclizineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.cyclobenzaprinedexmedetomidineandcyclobenzaprinebothincreasesedation.UseCaution/Monitor.cyproheptadinecyproheptadineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.dantrolenedexmedetomidineanddantrolenebothincreasesedation.UseCaution/Monitor.desfluranedesfluraneanddexmedetomidinebothincreasesedation.UseCaution/Monitor.desipraminedexmedetomidineanddesipraminebothincreasesedation.UseCaution/Monitor.dexchlorpheniraminedexchlorpheniramineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.dexfenfluraminedexmedetomidineincreasesanddexfenfluraminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dexmethylphenidatedexmedetomidineincreasesanddexmethylphenidatedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dextroamphetaminedexmedetomidineincreasesanddextroamphetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dextromoramidedexmedetomidineanddextromoramidebothincreasesedation.UseCaution/Monitor.diamorphinedexmedetomidineanddiamorphinebothincreasesedation.UseCaution/Monitor.diazepamdiazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.diazepamintranasaldiazepamintranasal,dexmedetomidine. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.UseCaution/Monitor.CoadministrationmaypotentiatetheCNS-depressanteffectsofeachdrug.dichlorphenamidedichlorphenamideanddexmedetomidinebothdecreaseserumpotassium.UseCaution/Monitor.diethylpropiondexmedetomidineincreasesanddiethylpropiondecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.difenoxinhcldexmedetomidineanddifenoxinhclbothincreasesedation.UseCaution/Monitor.dimenhydrinatedimenhydrinateanddexmedetomidinebothincreasesedation.UseCaution/Monitor.diphenhydraminediphenhydramineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.diphenoxylatehcldexmedetomidineanddiphenoxylatehclbothincreasesedation.UseCaution/Monitor.dipipanonedexmedetomidineanddipipanonebothincreasesedation.UseCaution/Monitor.dobutaminedexmedetomidineincreasesanddobutaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dopaminedexmedetomidineincreasesanddopaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dopexaminedexmedetomidineincreasesanddopexaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dosulepindexmedetomidineanddosulepinbothincreasesedation.UseCaution/Monitor.doxepindexmedetomidineanddoxepinbothincreasesedation.UseCaution/Monitor.doxylaminedexmedetomidineanddoxylaminebothincreasesedation.UseCaution/Monitor.droperidoldexmedetomidineanddroperidolbothincreasesedation.UseCaution/Monitor.eluxadolinedexmedetomidineincreaseslevelsofeluxadolinebyaffectinghepaticenzymeCYP2D6metabolism.UseCaution/Monitor.Asaprecautionarymeasureduetoincompleteinformationonthemetabolismofeluxadoline,usecautionwhencoadministeredwithstrongCYP2D6inhibitors.ephedrinedexmedetomidineincreasesandephedrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.epinephrinedexmedetomidineincreasesandepinephrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.epinephrineracemicdexmedetomidineincreasesandepinephrineracemicdecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.estazolamestazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.ethanoldexmedetomidineandethanolbothincreasesedation.UseCaution/Monitor.etomidateetomidateanddexmedetomidinebothincreasesedation.UseCaution/Monitor.fenfluraminedexmedetomidineincreasesandfenfluraminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.finerenonedexmedetomidinewillincreasetheleveloreffectoffinerenonebyaffectinghepatic/intestinalenzymeCYP3A4metabolism.ModifyTherapy/MonitorClosely.MonitorserumpotassiumduringinitiationanddosageadjustmentofeitherfinereroneorweakCYP3A4inhibitors.Adjustfinereronedosageasneeded.flibanserindexmedetomidineandflibanserinbothincreasesedation.ModifyTherapy/MonitorClosely.RiskforsedationincreasedifflibanseriniscoadministrationwithotherCNSdepressants.dexmedetomidinewillincreasetheleveloreffectofflibanserinbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.IncreasedflibanserinadverseeffectsmayoccurifcoadministeredwithmultipleweakCYP3A4inhibitors.fluphenazinedexmedetomidineandfluphenazinebothincreasesedation.UseCaution/Monitor.flurazepamflurazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.formoteroldexmedetomidineincreasesandformoteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.gotukolagotukolaincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.haloperidoldexmedetomidineandhaloperidolbothincreasesedation.UseCaution/Monitor.hawthornhawthornincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.hopshopsincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.hydromorphonedexmedetomidineandhydromorphonebothincreasesedation.UseCaution/Monitor.hydroxyzinehydroxyzineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.iloperidonedexmedetomidineandiloperidonebothincreasesedation.UseCaution/Monitor.imipraminedexmedetomidineandimipraminebothincreasesedation.UseCaution/Monitor.isoproterenoldexmedetomidineincreasesandisoproterenoldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.ivacaftordexmedetomidineincreaseslevelsofivacaftorbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.MonitorwhencoadministeredwithweakCYP3A4inhibitors.kavakavaincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.ketamineketamineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.ketotifen,ophthalmicdexmedetomidineandketotifen,ophthalmicbothincreasesedation.UseCaution/Monitor.lemborexantdexmedetomidinewillincreasetheleveloreffectoflemborexantbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.ModifyTherapy/MonitorClosely.LowernightlydoseoflemborexantrecommendedifcoadministeredwithweakCYP3A4inhibitors.Seedrugmonographforspecificdosagemodification.levalbuteroldexmedetomidineincreasesandlevalbuteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.levorphanoldexmedetomidineandlevorphanolbothincreasesedation.UseCaution/Monitor.lisdexamfetaminedexmedetomidineincreasesandlisdexamfetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.lofepraminedexmedetomidineandlofepraminebothincreasesedation.UseCaution/Monitor.lofexidinedexmedetomidineandlofexidinebothincreasesedation.UseCaution/Monitor.lomitapidedexmedetomidineincreaseslevelsoflomitapidebyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.Lomitapidedoseshouldnotexceed30mg/day.loprazolamloprazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.lorazepamlorazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.lormetazepamlormetazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.loxapinedexmedetomidineandloxapinebothincreasesedation.UseCaution/Monitor.loxapineinhaleddexmedetomidineandloxapineinhaledbothincreasesedation.UseCaution/Monitor.lurasidonelurasidoneanddexmedetomidinebothincreasepharmacodynamicsynergism.UseCaution/Monitor.PotentialforadditiveCNSeffectsmaprotilinedexmedetomidineandmaprotilinebothincreasesedation.UseCaution/Monitor.marijuanadexmedetomidineandmarijuanabothincreasesedation.UseCaution/Monitor.melatonindexmedetomidineandmelatoninbothincreasesedation.UseCaution/Monitor.meperidinedexmedetomidineandmeperidinebothincreasesedation.UseCaution/Monitor.meprobamatedexmedetomidineandmeprobamatebothincreasesedation.UseCaution/Monitor.metaproterenoldexmedetomidineincreasesandmetaproterenoldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.metaxalonedexmedetomidineandmetaxalonebothincreasesedation.UseCaution/Monitor.methadonedexmedetomidineandmethadonebothincreasesedation.UseCaution/Monitor.methamphetaminedexmedetomidineincreasesandmethamphetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.methocarbamoldexmedetomidineandmethocarbamolbothincreasesedation.UseCaution/Monitor.methylenedioxymethamphetaminedexmedetomidineincreasesandmethylenedioxymethamphetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.midazolammidazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.midazolamintranasaldexmedetomidinewillincreasetheleveloreffectofmidazolamintranasalbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.CoadministrationofmildCYP3A4inhibitorswithmidazolamintranasalmaycausehighermidazolamsystemicexposure,whichmayprolongsedation.midazolamintranasal,dexmedetomidine. Eitherincreasestoxicityoftheotherbypharmacodynamicsynergism.ModifyTherapy/MonitorClosely.Concomitantuseofbarbiturates,alcohol,orotherCNSdepressantsmayincreaseriskofhypoventilation,airwayobstruction,desaturation,orapneaandmaycontributetoprofoundand/orprolongeddrugeffect.midodrinedexmedetomidineincreasesandmidodrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.mirtazapinedexmedetomidineandmirtazapinebothincreasesedation.UseCaution/Monitor.modafinildexmedetomidineincreasesandmodafinildecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.morphinedexmedetomidineandmorphinebothincreasesedation.UseCaution/Monitor.motherwortdexmedetomidineandmotherwortbothincreasesedation.UseCaution/Monitor.moxonidinedexmedetomidineandmoxonidinebothincreasesedation.UseCaution/Monitor.nabilonedexmedetomidineandnabilonebothincreasesedation.UseCaution/Monitor.nalbuphinedexmedetomidineandnalbuphinebothincreasesedation.UseCaution/Monitor.norepinephrinedexmedetomidineincreasesandnorepinephrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.nortriptylinedexmedetomidineandnortriptylinebothincreasesedation.UseCaution/Monitor.olanzapinedexmedetomidineandolanzapinebothincreasesedation.UseCaution/Monitor.oliceridinedexmedetomidine,oliceridine. Eitherincreasestoxicityoftheotherbypharmacodynamicsynergism.ModifyTherapy/MonitorClosely.Profoundsedation,respiratorydepression,coma,anddeathmayresultifcoadministered.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.opiumtincturedexmedetomidineandopiumtincturebothincreasesedation.UseCaution/Monitor.orphenadrinedexmedetomidineandorphenadrinebothincreasesedation.UseCaution/Monitor.oxazepamoxazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.oxycodonedexmedetomidineandoxycodonebothincreasesedation.UseCaution/Monitor.oxymorphonedexmedetomidineandoxymorphonebothincreasesedation.UseCaution/Monitor.paliperidonedexmedetomidineandpaliperidonebothincreasesedation.UseCaution/Monitor.papaveretumdexmedetomidineandpapaveretumbothincreasesedation.UseCaution/Monitor.papaverinedexmedetomidineandpapaverinebothincreasesedation.UseCaution/Monitor.passionflowerpassionflowerincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.pentazocinedexmedetomidineandpentazocinebothincreasesedation.UseCaution/Monitor.pentobarbitalpentobarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.perphenazinedexmedetomidineandperphenazinebothincreasesedation.UseCaution/Monitor.phendimetrazinedexmedetomidineincreasesandphendimetrazinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.phenobarbitalphenobarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.phenterminedexmedetomidineincreasesandphenterminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.phenylephrinedexmedetomidineincreasesandphenylephrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.phenylephrinePOdexmedetomidineincreasesandphenylephrinePOdecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor..pholcodinedexmedetomidineandpholcodinebothincreasesedation.UseCaution/Monitor.pimozidedexmedetomidineandpimozidebothincreasesedation.UseCaution/Monitor.pirbuteroldexmedetomidineincreasesandpirbuteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.primidoneprimidoneanddexmedetomidinebothincreasesedation.UseCaution/Monitor.prochlorperazinedexmedetomidineandprochlorperazinebothincreasesedation.UseCaution/Monitor.promethazinepromethazineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.propofolpropofolanddexmedetomidinebothincreasesedation.UseCaution/Monitor.propylhexedrinedexmedetomidineincreasesandpropylhexedrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.protriptylinedexmedetomidineandprotriptylinebothincreasesedation.UseCaution/Monitor.quazepamquazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.quetiapinedexmedetomidineandquetiapinebothincreasesedation.UseCaution/Monitor.ramelteondexmedetomidineandramelteonbothincreasesedation.UseCaution/Monitor.risperidonedexmedetomidineandrisperidonebothincreasesedation.UseCaution/Monitor.salmeteroldexmedetomidineincreasesandsalmeteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.scullcapdexmedetomidineandscullcapbothincreasesedation.UseCaution/Monitor.secobarbitalsecobarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.sevofluranesevofluraneanddexmedetomidinebothincreasesedation.UseCaution/Monitor.shepherd'spursedexmedetomidineandshepherd'spursebothincreasesedation.UseCaution/Monitor.sufentanildexmedetomidineandsufentanilbothincreasesedation.UseCaution/Monitor.tamoxifendexmedetomidine,tamoxifen.affectinghepaticenzymeCYP2D6metabolism.UseCaution/Monitor.CYP2D6inhibitiondecreasesmetabolismoftamoxifentohydroxytamoxifen,andN-desmethyltamoxifentoendoxifen(activemetaboliteswith100-foldgreateraffinityforestrogenreceptor);decreasedendoxifenlevelsmayresultinpoorclinicaloutcome.tamsulosindexmedetomidineincreaseslevelsoftamsulosinbyaffectinghepaticenzymeCYP2D6metabolism.UseCaution/Monitor.tapentadoldexmedetomidineandtapentadolbothincreasesedation.UseCaution/Monitor.tazemetostatdexmedetomidinewillincreasetheleveloreffectoftazemetostatbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.temazepamtemazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.terbutalinedexmedetomidineincreasesandterbutalinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.thioridazinedexmedetomidineandthioridazinebothincreasesedation.UseCaution/Monitor.thiothixenedexmedetomidineandthiothixenebothincreasesedation.UseCaution/Monitor.tinidazoledexmedetomidinewillincreasetheleveloreffectoftinidazolebyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.topiramatedexmedetomidineandtopiramatebothincreasesedation.ModifyTherapy/MonitorClosely.tramadoldexmedetomidineandtramadolbothincreasesedation.UseCaution/Monitor.trazodonedexmedetomidineandtrazodonebothincreasesedation.UseCaution/Monitor.triazolamtriazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.triclofosdexmedetomidineandtriclofosbothincreasesedation.UseCaution/Monitor.trifluoperazinedexmedetomidineandtrifluoperazinebothincreasesedation.UseCaution/Monitor.trimipraminedexmedetomidineandtrimipraminebothincreasesedation.UseCaution/Monitor.triprolidinetriprolidineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.valbenazinedexmedetomidinewillincreasetheleveloreffectofvalbenazinebyaffectinghepaticenzymeCYP2D6metabolism.ModifyTherapy/MonitorClosely.ConsiderreducingvalbenazinedosebasedontolerabilityifcoadministeredwithastrongCYP2D6inhibitor.valerianvalerianincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.xylometazolinedexmedetomidineincreasesandxylometazolinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.yohimbinedexmedetomidineincreasesandyohimbinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.ziconotidedexmedetomidineandziconotidebothincreasesedation.UseCaution/Monitor.ziprasidonedexmedetomidineandziprasidonebothincreasesedation.UseCaution/Monitor.zotepinedexmedetomidineandzotepinebothincreasesedation.UseCaution/Monitor.Minor(7)ashwagandhaashwagandhaincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.Minor/SignificanceUnknown.MayenhanceCNSdepression.brimonidinebrimonidineincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.Minor/SignificanceUnknown.IncreasedCNSdepression.eucalyptusdexmedetomidineandeucalyptusbothincreasesedation.Minor/SignificanceUnknown.nettlenettleincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.Minor/SignificanceUnknown.(Highdosenettle;theoreticalinteraction)MayenhanceCNSdepression.ruxolitinibdexmedetomidinewillincreasetheleveloreffectofruxolitinibbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.Minor/SignificanceUnknown.sagedexmedetomidineandsagebothincreasesedation.Minor/SignificanceUnknown.SiberianginsengSiberianginsengincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.Minor/SignificanceUnknown.MayenhanceCNSdepression.albuterolMonitorClosely(1)dexmedetomidineincreasesandalbuteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.alfentanilMonitorClosely(1)dexmedetomidineandalfentanilbothincreasesedation.UseCaution/Monitor.alprazolamMonitorClosely(1)alprazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.amitriptylineMonitorClosely(1)dexmedetomidineandamitriptylinebothincreasesedation.UseCaution/Monitor.amobarbitalMonitorClosely(1)amobarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.amoxapineMonitorClosely(1)dexmedetomidineandamoxapinebothincreasesedation.UseCaution/Monitor.apomorphineMonitorClosely(1)dexmedetomidineandapomorphinebothincreasesedation.UseCaution/Monitor.arformoterolMonitorClosely(1)dexmedetomidineincreasesandarformoteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.aripiprazoleMonitorClosely(1)dexmedetomidineandaripiprazolebothincreasesedation.UseCaution/Monitor.armodafinilMonitorClosely(1)dexmedetomidineincreasesandarmodafinildecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.ashwagandhaMinor(1)ashwagandhaincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.Minor/SignificanceUnknown.MayenhanceCNSdepression.atogepantMonitorClosely(1)dexmedetomidinewillincreasetheleveloreffectofatogepantbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.avapritinibMonitorClosely(1)dexmedetomidinewillincreasetheleveloreffectofavapritinibbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.axitinibMonitorClosely(1)dexmedetomidineincreaseslevelsofaxitinibbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.azelastineMonitorClosely(1)azelastineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.baclofenMonitorClosely(1)dexmedetomidineandbaclofenbothincreasesedation.UseCaution/Monitor.belladonnaandopiumMonitorClosely(1)dexmedetomidineandbelladonnaandopiumbothincreasesedation.UseCaution/Monitor.benazeprilMonitorClosely(1)dexmedetomidine,benazepril. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.UseCaution/Monitor.Increasesriskofhypotension.benperidolMonitorClosely(1)dexmedetomidineandbenperidolbothincreasesedation.UseCaution/Monitor.benzphetamineMonitorClosely(1)dexmedetomidineincreasesandbenzphetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.brexpiprazoleMonitorClosely(1)dexmedetomidinewillincreasetheleveloreffectofbrexpiprazolebyaffectinghepaticenzymeCYP2D6metabolism.ModifyTherapy/MonitorClosely.AdministerhalfoftheusualbrexpiprazoledosewhencoadministeredwithstrongCYP2D6inhibitors.Ifalsoadministeredwithastrong/moderateCYP3A4inhibitor,administeraquarterofbrexpiprazoledose.NOTE:InMDDclinicaltrials,brexpiprazoledosagewasnotadjustedforstrongCYP2D6inhibitors(eg,paroxetine,fluoxetine);thus,CYPconsiderationsarealreadyfactoredintogeneraldosingrecommendationsandbrexpiprazolemaybeadministeredwithoutdosageadjustmentinpatientswithMDD.brimonidineMinor(1)brimonidineincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.Minor/SignificanceUnknown.IncreasedCNSdepression.brompheniramineMonitorClosely(1)brompheniramineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.buprenorphineMonitorClosely(1)dexmedetomidineandbuprenorphinebothincreasesedation.UseCaution/Monitor.buprenorphinebuccalMonitorClosely(1)dexmedetomidineandbuprenorphinebuccalbothincreasesedation.UseCaution/Monitor.buprenorphine,long-actinginjectionMonitorClosely(1)dexmedetomidineincreasestoxicityofbuprenorphine,long-actinginjectionbypharmacodynamicsynergism.ModifyTherapy/MonitorClosely.CoadministrationofbuprenorphineandbenzodiazepinesorotherCNSdepressantsincreasesriskofadversereactionsincludingoverdose,respiratorydepression,anddeath.CessationofbenzodiazepinesorotherCNSdepressantsispreferredinmostcases.Insomecases,monitoringatahigherlevelofcarefortaperingCNSdepressantsmaybeappropriate.Inothers,graduallytaperingapatientoffofaprescribedbenzodiazepineorotherCNSdepressantordecreasingtothelowesteffectivedosemaybeappropriate.butabarbitalMonitorClosely(1)butabarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.butalbitalMonitorClosely(1)butalbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.butorphanolMonitorClosely(1)dexmedetomidineandbutorphanolbothincreasesedation.UseCaution/Monitor.caffeineMonitorClosely(1)dexmedetomidineincreasesandcaffeinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.calcium/magnesium/potassium/sodiumoxybatesSerious-UseAlternative(1)dexmedetomidine,calcium/magnesium/potassium/sodiumoxybates. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Profoundsedation,respiratorydepression,coma,anddeathmayresultifcoadministered.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.captoprilMonitorClosely(1)dexmedetomidine,captopril. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.UseCaution/Monitor.Bothdrugslowerbloodpressure.Monitorbloodpressure.carbinoxamineMonitorClosely(1)carbinoxamineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.carisoprodolMonitorClosely(1)dexmedetomidineandcarisoprodolbothincreasesedation.UseCaution/Monitor.cenobamateMonitorClosely(1)cenobamate,dexmedetomidine. Eitherincreaseseffectsoftheotherbysedation.UseCaution/Monitor.chloralhydrateMonitorClosely(1)chloralhydrateanddexmedetomidinebothincreasesedation.UseCaution/Monitor.chlordiazepoxideMonitorClosely(1)chlordiazepoxideanddexmedetomidinebothincreasesedation.UseCaution/Monitor.chlorpheniramineMonitorClosely(1)chlorpheniramineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.chlorpromazineMonitorClosely(1)dexmedetomidineandchlorpromazinebothincreasesedation.UseCaution/Monitor.chlorzoxazoneMonitorClosely(1)dexmedetomidineandchlorzoxazonebothincreasesedation.UseCaution/Monitor.cinnarizineMonitorClosely(1)cinnarizineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.clemastineMonitorClosely(1)clemastineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.clomipramineMonitorClosely(1)dexmedetomidineandclomipraminebothincreasesedation.UseCaution/Monitor.clonazepamMonitorClosely(1)clonazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.clorazepateMonitorClosely(1)clorazepateanddexmedetomidinebothincreasesedation.UseCaution/Monitor.clozapineMonitorClosely(1)dexmedetomidineandclozapinebothincreasesedation.UseCaution/Monitor.codeineMonitorClosely(1)dexmedetomidineandcodeinebothincreasesedation.UseCaution/Monitor.cyclizineMonitorClosely(1)cyclizineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.cyclobenzaprineMonitorClosely(1)dexmedetomidineandcyclobenzaprinebothincreasesedation.UseCaution/Monitor.cyproheptadineMonitorClosely(1)cyproheptadineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.dantroleneMonitorClosely(1)dexmedetomidineanddantrolenebothincreasesedation.UseCaution/Monitor.desfluraneMonitorClosely(1)desfluraneanddexmedetomidinebothincreasesedation.UseCaution/Monitor.desipramineMonitorClosely(1)dexmedetomidineanddesipraminebothincreasesedation.UseCaution/Monitor.dexchlorpheniramineMonitorClosely(1)dexchlorpheniramineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.dexfenfluramineMonitorClosely(1)dexmedetomidineincreasesanddexfenfluraminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dexmethylphenidateMonitorClosely(1)dexmedetomidineincreasesanddexmethylphenidatedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dextroamphetamineMonitorClosely(1)dexmedetomidineincreasesanddextroamphetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dextromoramideMonitorClosely(1)dexmedetomidineanddextromoramidebothincreasesedation.UseCaution/Monitor.diamorphineMonitorClosely(1)dexmedetomidineanddiamorphinebothincreasesedation.UseCaution/Monitor.diazepamMonitorClosely(1)diazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.diazepamintranasalMonitorClosely(1)diazepamintranasal,dexmedetomidine. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.UseCaution/Monitor.CoadministrationmaypotentiatetheCNS-depressanteffectsofeachdrug.dichlorphenamideMonitorClosely(1)dichlorphenamideanddexmedetomidinebothdecreaseserumpotassium.UseCaution/Monitor.diethylpropionMonitorClosely(1)dexmedetomidineincreasesanddiethylpropiondecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.difenoxinhclMonitorClosely(1)dexmedetomidineanddifenoxinhclbothincreasesedation.UseCaution/Monitor.dimenhydrinateMonitorClosely(1)dimenhydrinateanddexmedetomidinebothincreasesedation.UseCaution/Monitor.diphenhydramineMonitorClosely(1)diphenhydramineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.diphenoxylatehclMonitorClosely(1)dexmedetomidineanddiphenoxylatehclbothincreasesedation.UseCaution/Monitor.dipipanoneMonitorClosely(1)dexmedetomidineanddipipanonebothincreasesedation.UseCaution/Monitor.dobutamineMonitorClosely(1)dexmedetomidineincreasesanddobutaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dopamineMonitorClosely(1)dexmedetomidineincreasesanddopaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dopexamineMonitorClosely(1)dexmedetomidineincreasesanddopexaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.dosulepinMonitorClosely(1)dexmedetomidineanddosulepinbothincreasesedation.UseCaution/Monitor.doxepinMonitorClosely(1)dexmedetomidineanddoxepinbothincreasesedation.UseCaution/Monitor.doxylamineMonitorClosely(1)dexmedetomidineanddoxylaminebothincreasesedation.UseCaution/Monitor.droperidolMonitorClosely(1)dexmedetomidineanddroperidolbothincreasesedation.UseCaution/Monitor.eliglustatContraindicated(1)dexmedetomidineincreaseslevelsofeliglustatbyaffectinghepaticenzymeCYP2D6metabolism.Contraindicated.IfcoadministeredwithstrongormoderateCYP2D6inhibitors,reduceeliglustatdosefrom84mgBIDto84mgoncedailyinextensiveandintermediatemetabolizers;eliglustatiscontraindiatedifstrongormoderateCYP2D6inhibitorsaregivenconcomitantlywithstrongormoderateCYP3Ainhibitors.eluxadolineMonitorClosely(1)dexmedetomidineincreaseslevelsofeluxadolinebyaffectinghepaticenzymeCYP2D6metabolism.UseCaution/Monitor.Asaprecautionarymeasureduetoincompleteinformationonthemetabolismofeluxadoline,usecautionwhencoadministeredwithstrongCYP2D6inhibitors.ephedrineMonitorClosely(1)dexmedetomidineincreasesandephedrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.epinephrineMonitorClosely(1)dexmedetomidineincreasesandepinephrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.epinephrineracemicMonitorClosely(1)dexmedetomidineincreasesandepinephrineracemicdecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.estazolamMonitorClosely(1)estazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.ethanolMonitorClosely(1)dexmedetomidineandethanolbothincreasesedation.UseCaution/Monitor.etomidateMonitorClosely(1)etomidateanddexmedetomidinebothincreasesedation.UseCaution/Monitor.eucalyptusMinor(1)dexmedetomidineandeucalyptusbothincreasesedation.Minor/SignificanceUnknown.fenfluramineMonitorClosely(1)dexmedetomidineincreasesandfenfluraminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.finerenoneMonitorClosely(1)dexmedetomidinewillincreasetheleveloreffectoffinerenonebyaffectinghepatic/intestinalenzymeCYP3A4metabolism.ModifyTherapy/MonitorClosely.MonitorserumpotassiumduringinitiationanddosageadjustmentofeitherfinereroneorweakCYP3A4inhibitors.Adjustfinereronedosageasneeded.flibanserinMonitorClosely(2)dexmedetomidinewillincreasetheleveloreffectofflibanserinbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.IncreasedflibanserinadverseeffectsmayoccurifcoadministeredwithmultipleweakCYP3A4inhibitors.dexmedetomidineandflibanserinbothincreasesedation.ModifyTherapy/MonitorClosely.RiskforsedationincreasedifflibanseriniscoadministrationwithotherCNSdepressants.fluphenazineMonitorClosely(1)dexmedetomidineandfluphenazinebothincreasesedation.UseCaution/Monitor.flurazepamMonitorClosely(1)flurazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.formoterolMonitorClosely(1)dexmedetomidineincreasesandformoteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.gotukolaMonitorClosely(1)gotukolaincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.haloperidolMonitorClosely(1)dexmedetomidineandhaloperidolbothincreasesedation.UseCaution/Monitor.hawthornMonitorClosely(1)hawthornincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.hopsMonitorClosely(1)hopsincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.hydrocodoneSerious-UseAlternative(1)hydrocodone,dexmedetomidine. Eitherincreasestoxicityoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Profoundsedation,respiratorydepression,coma,anddeathmayresultifcoadministered.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.hydromorphoneMonitorClosely(1)dexmedetomidineandhydromorphonebothincreasesedation.UseCaution/Monitor.hydroxyzineMonitorClosely(1)hydroxyzineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.iloperidoneMonitorClosely(1)dexmedetomidineandiloperidonebothincreasesedation.UseCaution/Monitor.imipramineMonitorClosely(1)dexmedetomidineandimipraminebothincreasesedation.UseCaution/Monitor.isoproterenolMonitorClosely(1)dexmedetomidineincreasesandisoproterenoldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.ivacaftorMonitorClosely(1)dexmedetomidineincreaseslevelsofivacaftorbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.MonitorwhencoadministeredwithweakCYP3A4inhibitors.kavaMonitorClosely(1)kavaincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.ketamineMonitorClosely(1)ketamineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.ketotifen,ophthalmicMonitorClosely(1)dexmedetomidineandketotifen,ophthalmicbothincreasesedation.UseCaution/Monitor.lemborexantMonitorClosely(1)dexmedetomidinewillincreasetheleveloreffectoflemborexantbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.ModifyTherapy/MonitorClosely.LowernightlydoseoflemborexantrecommendedifcoadministeredwithweakCYP3A4inhibitors.Seedrugmonographforspecificdosagemodification.levalbuterolMonitorClosely(1)dexmedetomidineincreasesandlevalbuteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.levorphanolMonitorClosely(1)dexmedetomidineandlevorphanolbothincreasesedation.UseCaution/Monitor.lisdexamfetamineMonitorClosely(1)dexmedetomidineincreasesandlisdexamfetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.lofepramineMonitorClosely(1)dexmedetomidineandlofepraminebothincreasesedation.UseCaution/Monitor.lofexidineMonitorClosely(1)dexmedetomidineandlofexidinebothincreasesedation.UseCaution/Monitor.lomitapideMonitorClosely(1)dexmedetomidineincreaseslevelsoflomitapidebyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.Lomitapidedoseshouldnotexceed30mg/day.lonafarnibSerious-UseAlternative(1)dexmedetomidinewillincreasetheleveloreffectoflonafarnibbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.AvoidorUseAlternateDrug.Ifcoadministrationoflonafarnib(asensitiveCYP3Asubstrate)withweakCYP3Ainhibitorsisunavoidable,reduceto,orcontinuelonafarnibatstartingdose.Closelymonitorforarrhythmiasandevents(eg,syncope,heartpalpitations)sincelonafarnibeffectonQTintervalisunknown.loprazolamMonitorClosely(1)loprazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.lorazepamMonitorClosely(1)lorazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.lormetazepamMonitorClosely(1)lormetazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.loxapineMonitorClosely(1)dexmedetomidineandloxapinebothincreasesedation.UseCaution/Monitor.loxapineinhaledMonitorClosely(1)dexmedetomidineandloxapineinhaledbothincreasesedation.UseCaution/Monitor.lurasidoneMonitorClosely(1)lurasidoneanddexmedetomidinebothincreasepharmacodynamicsynergism.UseCaution/Monitor.PotentialforadditiveCNSeffectsmaprotilineMonitorClosely(1)dexmedetomidineandmaprotilinebothincreasesedation.UseCaution/Monitor.marijuanaMonitorClosely(1)dexmedetomidineandmarijuanabothincreasesedation.UseCaution/Monitor.melatoninMonitorClosely(1)dexmedetomidineandmelatoninbothincreasesedation.UseCaution/Monitor.meperidineMonitorClosely(1)dexmedetomidineandmeperidinebothincreasesedation.UseCaution/Monitor.meprobamateMonitorClosely(1)dexmedetomidineandmeprobamatebothincreasesedation.UseCaution/Monitor.metaproterenolMonitorClosely(1)dexmedetomidineincreasesandmetaproterenoldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.metaxaloneMonitorClosely(1)dexmedetomidineandmetaxalonebothincreasesedation.UseCaution/Monitor.methadoneMonitorClosely(1)dexmedetomidineandmethadonebothincreasesedation.UseCaution/Monitor.methamphetamineMonitorClosely(1)dexmedetomidineincreasesandmethamphetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.methocarbamolMonitorClosely(1)dexmedetomidineandmethocarbamolbothincreasesedation.UseCaution/Monitor.methylenedioxymethamphetamineMonitorClosely(1)dexmedetomidineincreasesandmethylenedioxymethamphetaminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.metoclopramideintranasalSerious-UseAlternative(1)dexmedetomidine,metoclopramideintranasal. EitherincreaseseffectsoftheotherbyOther(seecomment).AvoidorUseAlternateDrug. Comment:Avoiduseofmetoclopramideintranasalorinteractingdrug,dependingonimportanceofdrugtopatient.midazolamMonitorClosely(1)midazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.midazolamintranasalMonitorClosely(2)dexmedetomidinewillincreasetheleveloreffectofmidazolamintranasalbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.CoadministrationofmildCYP3A4inhibitorswithmidazolamintranasalmaycausehighermidazolamsystemicexposure,whichmayprolongsedation.midazolamintranasal,dexmedetomidine. Eitherincreasestoxicityoftheotherbypharmacodynamicsynergism.ModifyTherapy/MonitorClosely.Concomitantuseofbarbiturates,alcohol,orotherCNSdepressantsmayincreaseriskofhypoventilation,airwayobstruction,desaturation,orapneaandmaycontributetoprofoundand/orprolongeddrugeffect.midodrineMonitorClosely(1)dexmedetomidineincreasesandmidodrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.mirtazapineMonitorClosely(1)dexmedetomidineandmirtazapinebothincreasesedation.UseCaution/Monitor.modafinilMonitorClosely(1)dexmedetomidineincreasesandmodafinildecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.morphineMonitorClosely(1)dexmedetomidineandmorphinebothincreasesedation.UseCaution/Monitor.motherwortMonitorClosely(1)dexmedetomidineandmotherwortbothincreasesedation.UseCaution/Monitor.moxonidineMonitorClosely(1)dexmedetomidineandmoxonidinebothincreasesedation.UseCaution/Monitor.nabiloneMonitorClosely(1)dexmedetomidineandnabilonebothincreasesedation.UseCaution/Monitor.nalbuphineMonitorClosely(1)dexmedetomidineandnalbuphinebothincreasesedation.UseCaution/Monitor.nettleMinor(1)nettleincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.Minor/SignificanceUnknown.(Highdosenettle;theoreticalinteraction)MayenhanceCNSdepression.norepinephrineMonitorClosely(1)dexmedetomidineincreasesandnorepinephrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.nortriptylineMonitorClosely(1)dexmedetomidineandnortriptylinebothincreasesedation.UseCaution/Monitor.olanzapineMonitorClosely(1)dexmedetomidineandolanzapinebothincreasesedation.UseCaution/Monitor.oliceridineMonitorClosely(1)dexmedetomidine,oliceridine. Eitherincreasestoxicityoftheotherbypharmacodynamicsynergism.ModifyTherapy/MonitorClosely.Profoundsedation,respiratorydepression,coma,anddeathmayresultifcoadministered.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.opiumtinctureMonitorClosely(1)dexmedetomidineandopiumtincturebothincreasesedation.UseCaution/Monitor.orphenadrineMonitorClosely(1)dexmedetomidineandorphenadrinebothincreasesedation.UseCaution/Monitor.oxazepamMonitorClosely(1)oxazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.oxycodoneMonitorClosely(1)dexmedetomidineandoxycodonebothincreasesedation.UseCaution/Monitor.oxymorphoneMonitorClosely(1)dexmedetomidineandoxymorphonebothincreasesedation.UseCaution/Monitor.paliperidoneMonitorClosely(1)dexmedetomidineandpaliperidonebothincreasesedation.UseCaution/Monitor.papaveretumMonitorClosely(1)dexmedetomidineandpapaveretumbothincreasesedation.UseCaution/Monitor.papaverineMonitorClosely(1)dexmedetomidineandpapaverinebothincreasesedation.UseCaution/Monitor.passionflowerMonitorClosely(1)passionflowerincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.pentazocineMonitorClosely(1)dexmedetomidineandpentazocinebothincreasesedation.UseCaution/Monitor.pentobarbitalMonitorClosely(1)pentobarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.perphenazineMonitorClosely(1)dexmedetomidineandperphenazinebothincreasesedation.UseCaution/Monitor.phendimetrazineMonitorClosely(1)dexmedetomidineincreasesandphendimetrazinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.phenobarbitalMonitorClosely(1)phenobarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.phentermineMonitorClosely(1)dexmedetomidineincreasesandphenterminedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.phenylephrineMonitorClosely(1)dexmedetomidineincreasesandphenylephrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.phenylephrinePOMonitorClosely(1)dexmedetomidineincreasesandphenylephrinePOdecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor..pholcodineMonitorClosely(1)dexmedetomidineandpholcodinebothincreasesedation.UseCaution/Monitor.pimozideMonitorClosely(1)dexmedetomidineandpimozidebothincreasesedation.UseCaution/Monitor.pirbuterolMonitorClosely(1)dexmedetomidineincreasesandpirbuteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.ponesimodSerious-UseAlternative(1)ponesimod,dexmedetomidine. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Consultcardiologistifconsideringtreatment.CoadministrationofponesimodwithdrugsthatdecreaseHRmayhaveadditiveeffectsondecreasingHRandshouldgenerallynotbeinitiatedinthesepatients.primidoneMonitorClosely(1)primidoneanddexmedetomidinebothincreasesedation.UseCaution/Monitor.prochlorperazineMonitorClosely(1)dexmedetomidineandprochlorperazinebothincreasesedation.UseCaution/Monitor.promethazineMonitorClosely(1)promethazineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.propofolMonitorClosely(1)propofolanddexmedetomidinebothincreasesedation.UseCaution/Monitor.propylhexedrineMonitorClosely(1)dexmedetomidineincreasesandpropylhexedrinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.protriptylineMonitorClosely(1)dexmedetomidineandprotriptylinebothincreasesedation.UseCaution/Monitor.quazepamMonitorClosely(1)quazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.quetiapineMonitorClosely(1)dexmedetomidineandquetiapinebothincreasesedation.UseCaution/Monitor.ramelteonMonitorClosely(1)dexmedetomidineandramelteonbothincreasesedation.UseCaution/Monitor.risperidoneMonitorClosely(1)dexmedetomidineandrisperidonebothincreasesedation.UseCaution/Monitor.ruxolitinibMinor(1)dexmedetomidinewillincreasetheleveloreffectofruxolitinibbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.Minor/SignificanceUnknown.sageMinor(1)dexmedetomidineandsagebothincreasesedation.Minor/SignificanceUnknown.salmeterolMonitorClosely(1)dexmedetomidineincreasesandsalmeteroldecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.scullcapMonitorClosely(1)dexmedetomidineandscullcapbothincreasesedation.UseCaution/Monitor.secobarbitalMonitorClosely(1)secobarbitalanddexmedetomidinebothincreasesedation.UseCaution/Monitor.sevofluraneMonitorClosely(1)sevofluraneanddexmedetomidinebothincreasesedation.UseCaution/Monitor.shepherd'spurseMonitorClosely(1)dexmedetomidineandshepherd'spursebothincreasesedation.UseCaution/Monitor.SiberianginsengMinor(1)Siberianginsengincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.Minor/SignificanceUnknown.MayenhanceCNSdepression.sodiumoxybateSerious-UseAlternative(1)dexmedetomidine,sodiumoxybate. Eitherincreaseseffectsoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Profoundsedation,respiratorydepression,coma,anddeathmayresultifcoadministered.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.sufentanilMonitorClosely(1)dexmedetomidineandsufentanilbothincreasesedation.UseCaution/Monitor.sufentanilSLSerious-UseAlternative(1)sufentanilSL,dexmedetomidine. Eitherincreasestoxicityoftheotherbypharmacodynamicsynergism.AvoidorUseAlternateDrug.Coadministrationmayresultinhypotension,profoundsedation,respiratorydepression,coma,anddeath.Reserveconcomitantprescribingofthesedrugsinpatientsforwhomothertreatmentoptionsareinadequate.Limitdosagesanddurationstotheminimumrequired.Monitorcloselyforsignsofrespiratorydepressionandsedation.tamoxifenMonitorClosely(1)dexmedetomidine,tamoxifen.affectinghepaticenzymeCYP2D6metabolism.UseCaution/Monitor.CYP2D6inhibitiondecreasesmetabolismoftamoxifentohydroxytamoxifen,andN-desmethyltamoxifentoendoxifen(activemetaboliteswith100-foldgreateraffinityforestrogenreceptor);decreasedendoxifenlevelsmayresultinpoorclinicaloutcome.tamsulosinMonitorClosely(1)dexmedetomidineincreaseslevelsoftamsulosinbyaffectinghepaticenzymeCYP2D6metabolism.UseCaution/Monitor.tapentadolMonitorClosely(1)dexmedetomidineandtapentadolbothincreasesedation.UseCaution/Monitor.tazemetostatMonitorClosely(1)dexmedetomidinewillincreasetheleveloreffectoftazemetostatbyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.temazepamMonitorClosely(1)temazepamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.terbutalineMonitorClosely(1)dexmedetomidineincreasesandterbutalinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.thioridazineMonitorClosely(1)dexmedetomidineandthioridazinebothincreasesedation.UseCaution/Monitor.thiothixeneMonitorClosely(1)dexmedetomidineandthiothixenebothincreasesedation.UseCaution/Monitor.tinidazoleMonitorClosely(1)dexmedetomidinewillincreasetheleveloreffectoftinidazolebyaffectinghepatic/intestinalenzymeCYP3A4metabolism.UseCaution/Monitor.topiramateMonitorClosely(1)dexmedetomidineandtopiramatebothincreasesedation.ModifyTherapy/MonitorClosely.tramadolMonitorClosely(1)dexmedetomidineandtramadolbothincreasesedation.UseCaution/Monitor.trazodoneMonitorClosely(1)dexmedetomidineandtrazodonebothincreasesedation.UseCaution/Monitor.triazolamMonitorClosely(1)triazolamanddexmedetomidinebothincreasesedation.UseCaution/Monitor.triclofosMonitorClosely(1)dexmedetomidineandtriclofosbothincreasesedation.UseCaution/Monitor.trifluoperazineMonitorClosely(1)dexmedetomidineandtrifluoperazinebothincreasesedation.UseCaution/Monitor.trimipramineMonitorClosely(1)dexmedetomidineandtrimipraminebothincreasesedation.UseCaution/Monitor.triprolidineMonitorClosely(1)triprolidineanddexmedetomidinebothincreasesedation.UseCaution/Monitor.valbenazineMonitorClosely(1)dexmedetomidinewillincreasetheleveloreffectofvalbenazinebyaffectinghepaticenzymeCYP2D6metabolism.ModifyTherapy/MonitorClosely.ConsiderreducingvalbenazinedosebasedontolerabilityifcoadministeredwithastrongCYP2D6inhibitor.valerianMonitorClosely(1)valerianincreaseseffectsofdexmedetomidinebypharmacodynamicsynergism.UseCaution/Monitor.MayenhanceCNSdepression.Serious-UseAlternative(1)valeriananddexmedetomidinebothincreasesedation.AvoidorUseAlternateDrug.vortioxetineSerious-UseAlternative(1)dexmedetomidineincreaseslevelsofvortioxetinebyaffectinghepaticenzymeCYP2D6metabolism.AvoidorUseAlternateDrug.Decreasevortioxetinedoseby50%whencoadministeredwithstrongCYP2D6inhibitors.xylometazolineMonitorClosely(1)dexmedetomidineincreasesandxylometazolinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.yohimbineMonitorClosely(1)dexmedetomidineincreasesandyohimbinedecreasessedation.Effectofinteractionisnotclear,usecaution.UseCaution/Monitor.ziconotideMonitorClosely(1)dexmedetomidineandziconotidebothincreasesedation.UseCaution/Monitor.ziprasidoneMonitorClosely(1)dexmedetomidineandziprasidonebothincreasesedation.UseCaution/Monitor.zotepineMonitorClosely(1)dexmedetomidineandzotepinebothincreasesedation.UseCaution/Monitor. PreviousNext:AdverseEffects >10%Hypotension(25-28%)Hypertension(12-16%)Nausea(9-11%)1-10%Bradycardia(5-7%)Pyrexia(4-5%)Atrialfibrillation(4%)Drymouth(3-4%)Vomiting(3-4%)Hypoxia(2-4%)Hypovolemia(3%)Atelectasis(3%)Tachycardia(2-3%)Postproceduralhemorrhage(2-3%)Anemia(2-3%)Agitation(2%)Hyperthermia(2%)Pain(2%)Hyperglycemia(2%)Chillsorrigors(2%)Hyperglycemia(2%)Oliguria(2%)Thirst(2%)Acidosis(1-2%)Pleuraleffusion(1-2%)Pulmonaryedema(1%)Hypocalcemia(1%)Urineoutputdecreased(1%)Sinustachycardia(1%)<1%VentriculartachycardiaWheezingPeripheraledemaPostmarketingReportsBloodandlymphaticsystemdisorders:AnemiaCardiacdisorders:Arrhythmia,atrialfibrillation,atrioventricularblock,bradycardia,cardiacarrest,cardiacdisorder,extrasystoles,myocardialinfarction,supraventriculartachycardia,tachycardia,ventriculararrhythmia,ventriculartachycardiaEyedisorders:Photopsia,visualimpairmentGastrointestinaldisorders:Abdominalpain,diarrhea,nausea,vomitingGeneral:Chills,hyperpyrexia,pain,pyrexia,thirstInvestigations:AST/ALTincreased,bloodalkalinephosphataseincreased,bloodureaincreased,EKGTwaveinversion,GGTincreased,QTprolongedMetabolismandnutritiondisorders:Acidosis,hyperkalemia,hypoglycemia,hypovolemia,hypernatremiaNervoussystemdisorders:Convulsion,dizziness,headache,neuralgia,neuritis,speechdisorderPsychiatricdisorders:Agitation,confusionalstate,delirium,hallucination,illusionRenalandurinarydisorders:Oliguria,polyuriaRespiratory,thoracic,andmediastinaldisorders:Apnea,bronchospasm,dyspnea,hypercapnia,hypoventilation,hypoxia,pulmonarycongestion,respiratoryacidosisSkinandsubcutaneoustissuedisorders:Hyperhidrosis,pruritus,rash,urticariaSurgicalandmedicalprocedures:LightanesthesiaVasculardisorders:Bloodpressurefluctuation,hemorrhage,hypertension,hypotension PreviousNext:Warnings ContraindicationsNoneCautionsContinuouslymonitorpatientswhileontherapy;therapyshouldbeadministeredonlybypersonsskilledinthemanagementofpatientsintheintensivecareoroperatingroomsettingBradycardiaandsinusarresthaveoccurredinyounghealthyvolunteerswithhighvagaltoneorwithdifferentroutesofadministration,includingrapidIVbolusadministrationCautionwithadvancedheartblockand/orsevereventriculardysfunction;becausedexmedetomidinedecreasessympatheticnervoussystemactivity,hypotensionand/orbradycardiamaybeexpectedtobemorepronouncedinpatientswithhypovolemia,diabetesmellitus,orchronichypertension,andinolderpatientsTransienthypertensionreportedprimarilyduringloadingdose;considerreductioninloadinginfusionratePatientscanbecomearoused/alertwithstimulation;thisaloneshouldnotbeconsideredaslackofefficacyProlongedexposuretodexmedetomidinebeyond24hoursmaybeassociatedwithtoleranceandtachyphylaxisandadose-relatedincreaseinadverseevents(eg,ARDS,respiratoryfailure,agitation)Usewithcautioninhepaticimpairment;considerdosereductionHypotensionandbradycardiamaynecessitatemedicalintervention;maybemorepronouncedinpatientswithhypovolemia,diabetesmellitus,orchronichypertension,andintheelderly;usewithcautioninpatientswithadvancedheartblockorsevereventriculardysfunctionWithdrawalsymptomsafterdiscontinuationreportedwhenadministeredforlongerthan6hr;mostcommoneventsreportedincludenausea,vomiting,andagitationTachycardiaandhypertensionreported,requiringintervention48hrfollowingstudydrugdiscontinuation;iftachycardiaand/orhypertensionoccursafterdiscontinuation,supportivetherapyisindicatedDruginteractionoverviewCautionifcoadministeredwithothervasodilatorsornegativechronotropicagentsowingtoadditivepharmacodynamiceffectsCoadministrationwithanesthetics,sedatives,hypnotics,andopioidsislikelytoleadtoanenhancementofpharmacodynamiceffects PreviousNext:Pregnancy&Lactation PregnancyTherearenoadequateandwell-controlledstudiesofuseinpregnantwomenInaninvitrohumanplacentastudy,placentaltransferofdexmedetomidineoccurredAnimalstudiesInpregnantrats,dexmedetomidineplacentaltransferobservedwhenradiolabeleddexmedetomidinewasadministeredSCThus,fetalexposureshouldbeexpectedinhumans;useduringpregnancyonlyifpotentialbenefitsjustifypotentialfetalriskLactationUnknownifexcretedinhumanmilkRadio-labeleddexmedetomidineadministeredSCtolactatingfemaleratswasexcretedinmilkBecausemanydrugsareexcretedinhumanmilk,cautionshouldbeexercisedwhenadministeredtobreastfeedingwomenPregnancyCategoriesA:Generallyacceptable.Controlledstudiesinpregnantwomenshownoevidenceoffetalrisk.B:Maybeacceptable.Eitheranimalstudiesshownoriskbuthumanstudiesnotavailableoranimalstudiesshowedminorrisksandhumanstudiesdoneandshowednorisk.C:Usewithcautionifbenefitsoutweighrisks.Animalstudiesshowriskandhumanstudiesnotavailableorneitheranimalnorhumanstudiesdone.D:UseinLIFE-THREATENINGemergencieswhennosaferdrugavailable.Positiveevidenceofhumanfetalrisk.X:Donotuseinpregnancy.Risksinvolvedoutweighpotentialbenefits.Saferalternativesexist.NA:Informationnotavailable. PreviousNext:Pharmacology MechanismofActionCentrallyactingalpha2-adrenoceptoragonistthathassedativeandanestheticpropertiespossiblybyactivatingG-proteinsinthebrainstem,whichresultsintheinhibitionofnorepinephrinereleasePharmacokineticsHalf-life,elimination:6min;2hr(terminal)Peakplasma:0.3-1.5ng/mLProteinbound:94%Vd:118LMetabolism:Liver,includingglucuronidationandCYP2A6Metabolites:3-hydroxy,3-carboxy,3-hydroxyN-methyl,3-carboxyN-methyl,andN-methylO-glucuronidedexmedetomidineTotalbodyclearance:39L/hrExcretion:Urine(95%);feces(4%) PreviousNext:Administration IVIncompatibilitiesY-site:amphotericinB,diazepamIVCompatibilitiesSolution:D5W,LR,0.9%NaCl,mannitol20%,MgSO4100mg/mL,KCl0.3%Y-site(partiallist):amiodarone,cefepime,cefoperazone,ceftriaxone,chlorpromazine,ciprofloxacin,clindamycin,digoxin,diphenhydramine,dobutamine,dopamine,epinephrine,fluconazole,furosemide,heparin,hydroxyzine,labetalol,lidocaine,linezolid,lorazepam,meperidine,metoclopramide,MgSO4,metronidazole,KCl,nitroglycerin,prochlorperazine,promethazine,NaHCO3,Na-nitroprusside,TMP-SMX,vancomycin,verapamilNotspecified:atracurium,atropine,etomidate,fentanyl,glycopyrrolate,midazolam,mivacurium,morphine,pancuronium,phenylephrine,succinylcholine,thiopental,vecuroniumIVPreparation200mcg/2mL(100mcg/mL)vialMustbedilutedwith0.9%NaCltoachieverequiredconcentration(4mcg/mL)beforePreparationofsolutionsisthesame,whetherfortheloadingdoseormaintenanceinfusionWithdraw2mLof100mcg/mLdexmedetomidineandaddto48mLof0.9%NaCltoatotalof50mLShakegentlytomixwellIVAdministrationUsecontrolledinfusiondevice;usecomponentsmadewithsyntheticorcoatednaturalrubbergasketsInfuseloadingdoseover10minMaintenancedose:AdministerbyIVcontinuousinfusionatrecommendedrate;individualizedinfusionrteandadjustratetodesiredclinicalresponseStorageControlledroomtemperatureof25ºC(77ºF);excursionsallowedfrom15-30ºC(59-86ºF) PreviousNext:Images BRAND FORM. UNITPRICE PILLIMAGE Precedexintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialdexmedetomidineintravenous-100mcg/mLvialCopyright©2010FirstDataBank,Inc. PreviousNext:PatientHandoutPrint NOMONOGRAPHAVAILABLEATTHISTIME USES:Consultyourpharmacist. HOWTOUSE:Consultyourpharmacist. SIDEEFFECTS:Consultyourpharmacist.IntheUS-Callyourdoctorformedicaladviceaboutsideeffects.YoumayreportsideeffectstoFDAat1-800-FDA-1088oratwww.fda.gov/medwatch.InCanada-Callyourdoctorformedicaladviceaboutsideeffects.YoumayreportsideeffectstoHealthCanadaat1-866-234-2345. PRECAUTIONS:Consultyourpharmacist. DRUGINTERACTIONS:Consultyourpharmacist.Keepalistofallyourmedicationswithyou,andsharethelistwithyourdoctorandpharmacist. OVERDOSE:Ifsomeonehasoverdosedandhasserioussymptomssuchaspassingoutortroublebreathing,call911.Otherwise,callapoisoncontrolcenterrightaway.USresidentscancalltheirlocalpoisoncontrolcenterat1-800-222-1222.Canadaresidentscancallaprovincialpoisoncontrolcenter. NOTES:Nomonographavailableatthistime. MISSEDDOSE:Consultyourpharmacist. STORAGE:Consultyourpharmacist.Donotflushmedicationsdownthetoiletorpourthemintoadrainunlessinstructedtodoso.Properlydiscardthisproductwhenitisexpiredornolongerneeded.Consultyourpharmacistorlocalwastedisposalcompanyformoredetailsabouthowtosafelydiscardyourproduct. InformationlastrevisedJuly2016.Copyright(c)2021FirstDatabank,Inc. IMPORTANT:HOWTOUSETHISINFORMATION:ThisisasummaryanddoesNOThaveallpossibleinformationaboutthisproduct.Thisinformationdoesnotassurethatthisproductissafe,effective,orappropriateforyou.Thisinformationisnotindividualmedicaladviceanddoesnotsubstitutefortheadviceofyourhealthcareprofessional.Alwaysaskyourhealthcareprofessionalforcompleteinformationaboutthisproductandyourspecifichealthneeds. PreviousNext:FormularyFormularyPatientDiscountsAddingplansallowsyoutocompareformularystatustootherdrugsinthesameclass.Toviewformularyinformationfirstcreatealistofplans.Yourlistwillbesavedandcanbeeditedatanytime.CreateYourListofPlansAddingplansallowsyouto:Viewtheformularyandanyrestrictionsforeachplan.Manageandviewallyourplanstogether–evenplansindifferentstates.Compareformularystatustootherdrugsinthesameclass.Accessyourplanlistonanydevice–mobileordesktop. Theaboveinformationisprovidedforgeneral informationalandeducationalpurposesonly.Individualplansmayvary andformularyinformationchanges.Contacttheapplicableplan providerforthemostcurrentinformation. Viewexplanationsfortiersand restrictions Tier Description 1 Thisdrugisavailableatthelowestco-pay.Most commonly,thesearegenericdrugs. 2 Thisdrugisavailableatamiddlelevelco-pay.Most commonly,theseare"preferred"(onformulary)branddrugs. 3 Thisdrugisavailableatahigherlevelco-pay.Most commonly,theseare"non-preferred"branddrugs. 4 Thisdrugisavailableatahigherlevelco-pay.Most commonly,theseare"non-preferred"branddrugsorspecialty prescriptionproducts. 5 Thisdrugisavailableatahigherlevelco-pay.Most commonly,theseare"non-preferred"branddrugsorspecialty prescriptionproducts. 6 Thisdrugisavailableatahigherlevelco-pay.Most commonly,theseare"non-preferred"branddrugsorspecialty prescriptionproducts. NC NOTCOVERED–Drugsthatarenot coveredbytheplan. Code Definition PA PriorAuthorizationDrugsthat requirepriorauthorization.Thisrestrictionrequiresthat specificclinicalcriteriabemetpriortotheapprovalofthe prescription. QL QuantityLimitsDrugsthat havequantitylimitsassociatedwitheachprescription.This restrictiontypicallylimitsthequantityofthedrugthatwill becovered. ST StepTherapyDrugsthathave steptherapyassociatedwitheachprescription.Thisrestriction typicallyrequiresthatcertaincriteriabemetpriorto approvalfortheprescription. OR OtherRestrictionsDrugsthat haverestrictionsotherthanpriorauthorization,quantity limits,andsteptherapyassociatedwitheachprescription. 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Close encodedsearchterm(dexmedetomidine(Precedex%2C))anddexmedetomidine(Precedex,) WhattoReadNextonMedscape MedscapeConsult News&Perspective DexmedetomidineforImprovedQualityofEmergenceFromGeneralAnesthesia ThreeDifferentAnesthesiaApproachesinBlepharoptosisSurgery DischargeReadinessAfterPropofolWithorWithoutDexmedetomidineforColonoscopy Tools DrugInteractionChecker PillIdentifier Calculators Formulary DrugClass Slideshow MedscapePsychiatristMalpracticeReport2019 MostPopularArticles AccordingtoPsychiatrists NeurodegenerativeNatureofSchizophreniaMakesCaseforLAIs ViewMore Recommended 2001 /viewarticle/878598 JournalArticle JournalArticle CombinedUseofDexmedetomidineandPropofolinMonitoredAnesthesiaCare NeedaCurbsideConsult? SharecasesandquestionswithPhysiciansonMedscapeconsult. Share aCase