In this episode, I’ll discuss 4 alternative routes of administration for dexmedetomidine.
Dexmedetomidine is an alpha2 adrenergic agonist sedative agent commonly used in the ICU as a continuous IV infusion.
However, alternative routes of administration for dexmedetomidine have been studied.
In a study of 120 adult patients, surgical patients were split equally between 4 groups – placebo, IV dexmedetomidine 1 mcg/kg, and intransal dexmedetomidine 1 mcg/kg or 2 mcg/kg. These patients were given single preoperative doses and the need for sedative and analgesic medications was measured and compared across groups. Intranasal dexmedetomidine significantly lessened the need for propofol, and the higher 2mcg/kg intranasal dose also reduced the amount of remifentanil needed for anesthesia maintenance as well as delayed the time to first request for postoperative analgesia. A study of intranasal dexmedetomidine pharmacokinetics and dynamics found bioavailability of about 40%, which can explain why a 2mcg/kg intranasal dose had the best effect in the surgical patients.
In a study of 8 healthy volunteers, dexmedetomidine 1 mcg/kg given subcutaneously reached peak levels in as early as 15 minutes and plasma concentrations associated with sedative effects were maintained for 4 hours after subcutaneous dosing.
In a study of 36 women undergoing modified radical mastectomy for breast cancer, dexmedetomidine was given buccally at doses of 0.5, 0.75, and 1 mcg/kg. The time to reach peak levels was 60 to 120 minutes with this route of administration.
In a randomized trial of 40 pre-op patients, dexmedetomidine 1 mcg/kg IM was compared with midazolam 0.02 mg/kg IM 30 minutes prior to anesthesia induction. Although plasma levels were not reported, levels of sedation were identical between groups, suggesting dexmedetomidine IM performed as well as midazolam.
These are relatively small studies and they do not change the principle way dexmedetomidine is administered in the ICU. However, the possibility exists that you will encounter a unique patient scenario where the sedative effects without respiratory suppression of dexmedetomidine are desired, but the IV route is not available. In such a case, being aware of the possibility of intranasal, subcutaneous, IM, or buccal administration of dexmedetomidine could be used to navigate an otherwise tricky or impossible clinical scenario.
Members of my Hospital Pharmacy Academy have access to practical training from a pharmacist’s point of view on using dexmedetomidine in critical care. This is in addition to many other resources to help in your practice. The Hospital Pharmacy Academy is my online membership site that teaches pharmacists practical critical care and hospital pharmacy skills you can apply at the bedside so that you can become confident in your ability to save lives and improve patient outcomes. To get immediate access, go to pharmacyjoe.com/academy.
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