Source: European Medicines Agency (EU) Revision Year: 2019 Publisher: Orion Corporation, Orionintie 1, FI-02200 Espoo, Finland
For sedation of adult ICU (Intensive Care Unit) patients requiring a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale (RASS) 0 to -3).
For sedation of non-intubated adult patients prior to and/or during diagnostic or surgical procedures requiring sedation, i.e. procedural/awake sedation.
For sedation of adult ICU (Intensive Care Unit) patients requiring a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale (RASS) 0 to -3).
For hospital use only. Dexdor should be administered by healthcare professionals skilled in the management of patients requiring intensive care.
Patients already intubated and sedated may switch to dexmedetomidine with an initial infusion rate of 0.7 micrograms/kg/h which may then be adjusted stepwise within the dose range 0.2 to 1.4 micrograms/kg/h in order to achieve the desired level of sedation, depending on the patient’s response. A lower starting infusion rate should be considered for frail patients. Dexmedetomidine is very potent and the infusion rate is given per hour. After dose adjustment, a new steady state sedation level may not be reached for up to one hour.
The maximum dose of 1.4 micrograms/kg/h should not be exceeded. Patients failing to achieve an adequate level of sedation with the maximum dose of dexmedetomidine should be switched to an alternative sedative agent.
Use of a loading dose of Dexdor in ICU sedation is not recommended and is associated with increased adverse reactions. Propofol or midazolam may be administered if needed until clinical effects of dexmedetomidine are established.
There is no experience in the use of Dexdor for more than 14 days. The use of Dexdor for longer than this period should be regularly reassessed.
For sedation of non-intubated adult patients prior to and/or during diagnostic or surgical procedures requiring sedation, i.e. procedural/awake sedation.
Dexdor should be administered only by health care professionals skilled in the anaesthetic management of patients in the operating room or during diagnostic procedures. When Dexdor is administered for conscious sedation, patients should be continuously monitored by persons not involved in the conduct of the diagnostic or surgical procedure. Patients should be monitored continuously for early signs of hypotension, hypertension, bradycardia, respiratory depression, airway obstruction, apnoea, dyspnoea and/or oxygen desaturation (see section 4.8).
Supplemental oxygen should be immediately available and provided when indicated. The oxygen saturation should be monitored by pulse oximetry.
Dexdor is given as a loading infusion followed by maintenance infusion. Depending on the procedure concomitant local anaesthesia or analgesia may be needed in order to achieve the desired clinical effect. Additional analgesia or sedatives (e.g. opioids, midazolam, or propofol) are recommended in case of painful procedures or if increased depth of sedation is necessary. The pharmacokinetic distribution half –life of Dexdor has been estimated to be around 6 min, which can be taken into consideration, together with the effects of other administered medications, when assessing the appropriate time needed for titration to desired clinical effect of Dexdor.
A loading infusion of 1.0 microgram/kg over 10 minutes. For less invasive procedures such as ophthalmic surgery, a loading infusion of 0.5 micrograms/kg given over 10 minutes may be suitable.
The maintenance infusion is generally initiated at 0.6-0.7 microgram/kg/hour and titrated to achieve desired clinical effect with doses ranging from 0.2 to 1 microgram/kg/hour. The rate of the maintenance infusion should be adjusted to achieve the targeted level of sedation.
No dose adjustment is normally required for elderly patients (see section 5.2). Elderly patients appear to have an increased risk for hypotension (see section 4.4) but the limited data available from procedural sedation do not suggest a clear dose dependency.
No dose adjustment is required for patients with renal impairment.
Dexmedetomidine is metabolised in the liver and should be used with caution in patients with hepatic impairment. A reduced maintenance dose may be considered (see sections 4.4 and 5.2).
The safety and efficacy of Dexdor in children aged 0 to 18 years have not been established. Currently available data are described in sections 4.8, 5.1 and 5.2 but no recommendation on a posology can be made.
Dexdor must be administered only as a diluted intravenous infusion using a controlled infusion device. For instructions on dilution of the medicinal product before administration, see section 6.6.
Several cases of dexmedetomidine overdose have been reported both in the clinical trial and the post-marketing data. The reported highest infusion rates of dexmedetomidine in these cases have reached up to 60 μg/kg/h for 36 minutes and 30 μg/kg/h for 15 minutes in a 20-month-old child and in an adult, respectively. The most common adverse reactions reported in conjunction with overdose include bradycardia, hypotension, hypertension, oversedation, respiratory depression and cardiac arrest.
In cases of overdose with clinical symptoms, dexmedetomidine infusion should be reduced or stopped. Expected effects are primarily cardiovascular and should be treated as clinically indicated (see section 4.4). At high concentration hypertension may be more prominent than hypotension. In clinical studies, cases of sinus arrest reversed spontaneously or responded to treatment with atropine and glycopyrrolate. Resuscitation was required in isolated cases of severe overdose resulting in cardiac arrest.
3 years.
After dilution: Chemical and physical in-use stability has been demonstrated for 24 hours at 25°C.
From a microbiological point of view, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to the use are the responsibility of the user and would not normally be longer than 24 hours at 2° to 8°C, unless dilution has taken place in controlled and validated aseptic conditions.
This medicinal product does not require any special temperature storage conditions. Keep the ampoules or vials in the outer carton in order to protect from light.
For storage conditions after dilution of the medicinal product, see section 6.3.
2 ml Type I glass ampoules.
2, 5 or 10 ml Type I glass vials (with filling volumes of 2, 4 and 10 ml), grey bromobutyl rubber closure with fluoropolymer coating.
Pack sizes:
5 × 2 ml ampoules
25 × 2 ml ampoules
5 × 2 ml vials
4 × 4 ml vials
4 × 10 ml vials
Not all pack sizes may be marketed.
Ampoules and vials are intended for single patient use only.
Dexdor can be diluted in glucose 50 mg/ml (5%), Ringers, mannitol or sodium chloride 9 mg/ml (0.9%) solution for injection to achieve the required concentration of either 4 micrograms/ml or 8 micrograms/ml prior to administration. Please see below in tabulated form the volumes needed to prepare the infusion.
In case the required concentration is 4 micrograms/ml:
| Volume of Dexdor 100 micrograms/ml concentrate for solution for infusion | Volume of diluent | Total volume of infusion |
|---|---|---|
| 2 ml | 48 ml | 50 ml |
| 4 ml | 96 ml | 100 ml |
| 10 ml | 240 ml | 250 ml |
| 20 ml | 480 ml | 500 ml |
In case the required concentration is 8 micrograms/ml:
| Volume of Dexdor 100 micrograms/ml concentrate for solution for infusion | Volume of diluent | Total volume of infusion |
|---|---|---|
| 4 ml | 46 ml | 50 ml |
| 8 ml | 92 ml | 100 ml |
| 20 ml | 230 ml | 250 ml |
| 40 ml | 460 ml | 500 ml |
The solution should be shaken gently to mix well.
Dexdor should be inspected visually for particulate matter and discoloration prior to administration.
Dexdor has been shown to be compatible when administered with the following intravenous fluids and medicinal products:
Lactated Ringers, 5% glucose solution, sodium chloride 9 mg/ml (0.9%) solution for injection, mannitol 200 mg/ml (20%), thiopental sodium, etomidate, vecuronium bromide, pancuronium bromide, succinylcholine, atracurium besylate, mivacurium chloride, rocuronium bromide, glycopyrrolate bromide, phenylephrine HCl, atropine sulfate, dopamine, noradrenaline, dobutamine, midazolam, morphine sulfate, fentanyl citrate, and a plasma-substitute.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
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