[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Intravenous anaesthetics](https://durgical.com/en/pharmacology/classes/intravenous-anaesthetics/) › Dexmedetomidine [Pharmacology](https://durgical.com/en/pharmacology/) · [Intravenous anaesthetics](https://durgical.com/en/pharmacology/classes/intravenous-anaesthetics/) # Dexmedetomidine Alpha-2 agonist sedative that leaves the patient calm but rousable, without much respiratory depression. It causes bradycardia and hypotension. Updated 2026-11-01 - Class: [Intravenous anaesthetics](https://durgical.com/en/pharmacology/classes/intravenous-anaesthetics/) - Receptor: Alpha-2A adrenergic receptor - ATC code: N05CM18 ## ⚠ High-alert medication An error with this medicine can cause serious harm: double checks and protocols are used. Also called: Dexmedetomidine hydrochloride ◎**Alpha-2A adrenergic receptor**Dexmedetomidine ⓘ The figure shows dexmedetomidine bound to the human alpha-2A adrenergic receptor in its active complex with a Go protein. **Target in 3D:** Alpha-2A adrenergic receptor. PDB structure 7EJA (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/7EJA) · Drag to rotate · pinch to zoom ## Mechanism of action Dexmedetomidine is a relatively selective agonist of alpha-2 adrenergic receptors. In the locus coeruleus it reduces the firing of noradrenergic neurons and produces a sedation that resembles natural sleep: the patient responds and cooperates when stimulated. By lowering sympathetic tone it reduces heart rate and blood pressure; at the start, blood pressure may rise through stimulation of vascular alpha-2 receptors. - Stimulates alpha-2 receptors in the locus coeruleus - Noradrenergic firing falls: sleep-like sedation - Patient rousable, with little respiratory depression - Lower sympathetic tone: bradycardia and hypotension ## Pharmacokinetics **Metabolism** Almost complete hepatic metabolism: direct glucuronidation and hydroxylation by CYP2A6; liver impairment reduces its clearance. **Elimination** Kidney, as inactive metabolites. **Onset and duration** Intravenous infusion; it can be started with a loading infusion. ## Indications - Sedation of intubated, ventilated ICU patients - Sedation of non-intubated patients before and during procedures - Sedation for awake fibreoptic intubation ## Adverse effects ### Common - Hypotension - Bradycardia - Dry mouth - Nausea - Transient hypertension during the loading infusion ### Serious (rare, important) - Severe bradycardia, sinus arrest and atrioventricular block - Withdrawal symptoms (tachycardia, hypertension, agitation) when long infusions stop - Diabetes insipidus - Tolerance with use beyond 24 hours ## Contraindications - Hypersensitivity to dexmedetomidine ## Key interactions **Anaesthetics, sedatives, hypnotics and opioids** Add sedation; lower doses may be needed. **Other vasodilators or drugs that slow the heart (beta-blockers)** Additive hypotension and bradycardia. ## What is monitored - Continuous heart rate, rhythm and blood pressure - Sedation level on a scale - Urine output, sodium and urine osmolality (diabetes insipidus) - Withdrawal signs on stopping ## Administration and safety - Continuous intravenous infusion by pump; rapid infusion or bolus raises the risk of bradycardia and sinus arrest. - The approved ICU sedation indication does not exceed 24 hours of infusion. - Ready-to-use presentations and concentrates that must be diluted both exist: confirm which one is at hand. ## Nursing care - Before: baseline heart rate and blood pressure; caution in hypovolaemia, heart block or severe ventricular dysfunction. - During: watch for bradycardia and hypotension; keep atropine available. - Remember that the patient may wake with stimulation: this does not mean the drug is failing. - When a long infusion stops: watch for agitation, tachycardia and hypertension. ## Pregnancy and breastfeeding Human data are too limited to establish a risk in pregnancy. ## Memory aid DEXmedetomidine: «Dozes but DEtects you»; like clonidine, it lowers pulse and pressure. ## Test yourself Think of the answer, then tap the question to see it. ## Why can a patient sedated with dexmedetomidine wake when spoken to? Because it produces a sleep-like sedation through its action in the locus coeruleus, not a global depression of the nervous system; waking with stimulation does not mean lack of effect. ## What are the most common adverse effects of dexmedetomidine? Hypotension, bradycardia and dry mouth. ## Which antihypertensive drug shares dexmedetomidine's mechanism? Clonidine, another alpha-2 adrenergic agonist. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/dexmedetomidine/) ## Related drugs - [Clonidine](https://durgical.com/en/pharmacology/clonidine/) - [Propofol](https://durgical.com/en/pharmacology/propofol/) [← Back to the class: Intravenous anaesthetics](https://durgical.com/en/pharmacology/classes/intravenous-anaesthetics/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - DEXMEDETOMIDINE HYDROCHLORIDE injection](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8ccb45a7-8290-469c-9644-a4dca967d88f) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 24 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N05CM18) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/dexmedetomidine/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/dexmedetomidine/