How To Transition Patients From Dexmedetomidine (Precedex) To Enteral Clonidine | Rx Duo | RxEconsult
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Transitioning Patients From Dexmedetomidine (Precedex) To Enteral Clonidine In The ICU Category: Pharmacotherapy by - November 11, 2016 | Views: 2140 | Likes: 0 | Comment: 0  

dexmedetomidine to clonidine

What is Dexmedetomidine (Precedex)?

Dexmedetomidine (Precedex) is a relatively selective alpha2-adrenergic agonist indicated for sedation in intubated or non-intubated patients and procedural sedation with minimal analgesic and sympatholytic properties but has no anticonvulsant properties.

Key properties of dexmedetomidine

  • It causes minimal respiratory depression and can be used in non-intubated patients.
  • The most common side effects are hypotension and bradycardia.
  • A bolus dose may be administered prior to starting a continuous infusion, but is more likely to cause hemodynamic instability in critically ill patients.
  • Patients with severe hepatic dysfunction have reduced clearance and may require lower doses.
  • The injection is available in glass vials ready to use and also to be used after dilution.

Guidelines for use of dexmedetomidine

The Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult patients in the Intensive Care Unit provides useful information and recommendations for the use of dexmedetomidine for sedation. In general, these guidelines suggest that non-benzodiazepine sedatives (propofol or dexmedetomidine) may be preferred over sedation with benzodiazepines (midazolam or lorazepam) to improve clinical outcomes.

Clinical studies about transitioning from dexmedetomidine to clonidine

Dexmedetomidine is a useful drug that has a special niche in the critical care arena. It causes minimal respiratory depression and can be used as a bridge to extubation in agitated patients. It is an expensive sedative that is indicated for sedation in the ICU not to exceed 24 hours. Transitioning patients from intravenous dexmedetomidine to enteral clonidine is a potentially effective and less expensive alternative.

Study #1

Evaluating the Transition From Dexmedetomidine to Clonidine for Agitation Management in the Intensive Care Unit

This was a single-center, retrospective analysis designed to assess the safety and efficacy of transitioning patients (> 18 years of age) from dexmedetomidine to enteral clonidine for sedation management in the ICU. In this study, the transition from dexmedetomidine to enteral clonidine was not by protocol and was initiated at the discretion of the attending physician. A total of 26 patients were evaluated with a mean age of 54.4 years.

Efficacy: Dexmedetomidine discontinuation occurred in 17 (65.4%) patients within 8 hours of receiving clonidine. Three (11.5%) patients were able to stop dexmedetomidine within 17-24 hours, while 6 (23.1%) patients were unable to stop dexmedetomidine until 24 or more hours after receiving clonidine. Initial clonidine doses were 0.1 mg in most patients and titrated up every 6 to 8 hours. The median clonidine dose was 0.35 mg per ICU day in patients who stopped dexmedetomidine within 8 hours and 0.5 mg per ICU day in patients who did not (p = 0.036). It is important to note that the dexmedetomidine interquartile range dosage was 0 to 0.25 mcg/kg/hour in patients with a time to dexmedetomidine discontinuation time of 8 hours or less compared to 0.45 – 0.7 mcg/kg/hour in patients with a dexmedetomidine discontinuation time of greater than 8 hours (p = 0.005).

Safety: There were no statistical differences in safety endpoints.

Next: Study #2

 

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