dexmedetomidine, 프레세덱스 주

 

PRECEDEX의 FDA label

Final concentration : 4mcg/mL 

For Adult Intensive Care Unit Sedation 
LD 1 mcg/kg (over 10 min)
MD 0.2-0.7 mcg/kg/hr

For Adult Procedural Sedation
LD 1 mcg/kg (over 10 min)
MD 0.6 mcg/kg/hr → titrated to achieve desired clinical effect with doses ranging from 0.2 to 1 mcg/kg/hour

 

 

lexicomp의 dosing

Usual dosage range: 0.2 to 1.5 mcg/kg/hour; titrate by 0.2 mcg/kg/hour every 30 minutes to sedation goal or clinical effect 

📌 2.5 mcg/kg/hr 정도로 사용되기도 하지만, 1.5 mcg/kg/hr 이상의 용량에 대해서는 추가적인 임상적 효과를 기대하기 어려움. 
📌 제약사는 24시간 이상 사용을 권고하지 않고 있디만 많은 임상 연구에서 ~14일 정도의 장기 사용 시, efficacy와 safety가 검증됨(vs lorezepam, midazolam)
📌 Withdrawal symptoms (eg, hypertension, tachycardia, delirium, agitation)의 risk factor : 
고혈압 기저력, receiving continuous infusions for longer durations, with greater cumulative daily doses (eg, >12 mcg/kg/day), or with higher peak rates (eg, >0.8 mcg/kg/hour)
이러한 환자들은 갑작스러운 약제의 중단 금기

 

주의사항

🌵 심혈관계 부작용

- Transient Hypertension: Observed primarily during the loading dose Consider reduction in loading infusion rate

- Bradycardia and/or hypotension may occur with loading doses. Transient, paradoxical hypertension may also occur with loading doses; however, this is dependent on high peak plasma concentrations (eg, during rapid loading administration). Bradycardia and hypertension may occur with higher maintenance doses. Hypotension may also occur during titration, with dose escalations that occur more frequently than every 30 minutes

🌵 Tolerance and Tachyphylaxis: Prolonged exposure to dexmedetomidine beyond 24 hours may be associated with tolerance and tachyphylaxis and a dose-related increase in adverse events

 

부작용

- 가장 흔한 부작용(incidence >2%) : hypotension, bradycardia, dry mouth

 

 

 

reference ;

1) lexicomp

2) precedex label