In this episode, I’ll discuss 3 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 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.
While these are small studies and will not change the main way dexmedetomidine is administered in the ICU, there may be a unique patient scenario that presents itself where the sedative effects without respiratory suppression of dexmedetomidine are desired, but the IV route is not available. In such a case clinicians may wish to consider whether subcutaneous, IM, or buccal administration of dexmedetomidine could be used.
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.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.