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Dexmedetomidine, sold under the trade names Precedex and Dexdor, among others, is an anxiolytic, sedative, and analgesic medication. Similar to clonidine, it is an agonist of α₂-adrenergic receptors in certain parts of the brain.^[1] Dexmedetomidine is notable for its ability to provide sedation without risk of respiratory depression (unlike other commonly used sedatives such as propofol, fentanyl, and midazolam) and can provide cooperative or semi-arousable sedation. Dexmedetomidine hydrochloride is also used in veterinary medicine for dogs and cats.^[2] The drug was developed by Orion Pharma.^[3]

Medical uses

Intensive care unit sedation

Dexmedetomidine is most often used in the intensive care setting for light to moderate sedation. It is not recommended for long term deep sedation. A unique feature of dexmedetomidine is that it has analgesic properties in addition to its role as a hypnotic, but is opioid sparing, and is therefore not associated with significant respiratory depression (unlike propofol).

Many studies suggest dexmedetomidine for sedation in mechanically ventilated adults may reduce time to extubation and ICU stay.^[4]^[5] People on dexmedetomidine are rousable and cooperative, and as such are able to actively cooperative with various procedures.

Compared with other sedatives, some studies suggest dexmedetomidine may be associated with less delirium.^[6] However, this finding is not consistent across multiple studies.^[5] At the very least, when aggregating many study results together, usage of dexmedetomidine appears to be associated with less neurocognitive dysfunction compared to other sedatives.^[7] Whether this has beneficial psychological impact is unclear.^[8] From an economic perspective, dexmedetomidine is associated with lower ICU costs.^[9] These decreased costs are largely due to a shorter time to extubation.

Procedural sedation

Dexmedetomidine can also be used as sedoanalgesic for procedural sedation, such as during colonoscopy.^[10] It can be used as an adjunct with other sedatives like benzodiazepines, opiates, and propofol to enhance sedation and help maintain hemodynamic stability by decreasing the requirement of other sedatives.^[11]^[12] Dexmedetomidine is also used for procedural sedation in children.^[13]

Other

Dexmedetomidine may be useful for the treatment of the negative cardiovascular effects of acute amphetamines and cocaine intoxication and overdose.^[14]^[15]

Dosage and administration

Intravenous infusion of dexmedetomidine is commonly initiated with a loading dose followed by a maintenance infusion. There may be great individual variability in the hemodynamic effects (especially on heart rate and blood pressure), as well as the sedative effects of this drug. For this reason, the dose must be carefully adjusted to achieve the desired clinical effect.^[16]

Side effects

There are no absolute contraindications to the use of dexmedetomidine. Dexmedetomidine has a biphasic effect on blood pressure with decreased blood pressure observed at lower concentrations and elevated blood pressure at higher concentrations.^[17] Rapid IV administration or bolus has been associated with slow heart rate (bradycardia) and low blood pressure (hypotension) due to peripheral α₂-receptor stimulation.

Interactions

Dexemedetomidine may enhance the effects of other sedatives and anesthetics when co-administered. Similarly, drugs that lower blood pressure and heart rate, such as beta blockers, may also have enhanced effects when co-administered with dexmedetomidine.^[18]

Pharmacodynamics

Dexmedetomidine is a highly selective α₂-adrenergic agonist. Unlike opioids and other sedatives such as propofol, dexmedetomidine is able to achieve its effects without causing respiratory depression. Dexmedetomidine induces sedation by decreasing activity of neurons in the locus ceruleus in the brain stem, thereby increasing activity of inhibitory gamma-aminobutyric acid neurons in the ventrolateral preoptic nucleus.^[19] In contrast, other sedatives like propofol and benzodiazepines directly increase activity of gamma-aminobutyric acid neurons.^[20] Sedation by dexemeditomidine mirrors natural sleep.^[21] As such, dexmedetomidine provides less amnesia compared to benzodiazepines.^[20] Dexmedetomidine also has analgesic effects at the spinal cord level and other supraspinal sites.^[20] Thus, unlike other hypnotic agents like propofol, dexmedetomidine can be used as an adjunct medication to help decrease the opioid requirements of people in pain while still providing similar analgesia.

Pharmacokinetics

Intravenous dexmedetomidine exhibits linear pharmacokinetics with a rapid distribution half-life of approximately 6 minutes and a terminal elimination half-life of approximately 2 hours. Plasma protein binding of dexemedotomindine is ~94% (mostly albumin).^[22]

Dexmedetomidine is metabolized by the liver via glucuronidation and cytochrome P450. As such, this drug should be used with caution in people with liver disease.^[18]

The majority of metabolized dexmedetomidine is excreted in the urine ~95%.

History

Dexmedetomidine was approved in 1999 by the Food and Drug Administration (FDA) as a short term sedative and analgesic (<24 hours) for critically ill or injured people on mechanical ventilation in the intensive care unit (ICU). The rationale for its use short term was due to concerns over withdrawal side effects, such as rebound high blood pressure. These withdrawal side effects have not been consistently observed in research studies, however.^[23] More recently, in 2008 the FDA expanded its indication to include nonintubated people requiring sedation for surgical or non-surgical procedures, such as colonoscopy.

References

^ Cormack JR, Orme RM, Costello TG (2005). "The role of alpha2-agonists in neurosurgery". Journal of Clinical Neuroscience 12 (4): 375–8. doi:10.1016/j.jocn.2004.06.008. PMID 15925765.
^ http://www.dexdomitor.com/
^ http://orion.fi/en/Research-and-developement/Achievements/
^ Pasin, Laura; Greco, Teresa; Feltracco, Paolo; Vittorio, Annalisa; Neto, Caetano Nigro; Cabrini, Luca; Landoni, Giovanni; Finco, Gabriele; Zangrillo, Alberto (2013-01-01). "Dexmedetomidine as a sedative agent in critically ill patients: a meta-analysis of randomized controlled trials". PloS One 8 (12): e82913. doi:10.1371/journal.pone.0082913. ISSN 1932-6203. PMC 3877008. PMID 24391726.
^ ^a ^b Chen, Ken; Lu, Zhijun; Xin, Yi Chun; Cai, Yong; Chen, Yi; Pan, Shu Ming (2015-01-01). "Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients". The Cochrane Database of Systematic Reviews 1: CD010269. ISSN 1469-493X. PMID 25879090.
^ MacLaren, Robert; Preslaski, Candice R.; Mueller, Scott W.; Kiser, Tyree H.; Fish, Douglas N.; Lavelle, James C.; Malkoski, Stephen P. (2015-03-01). "A randomized, double-blind pilot study of dexmedetomidine versus midazolam for intensive care unit sedation: patient recall of their experiences and short-term psychological outcomes". Journal of Intensive Care Medicine 30 (3): 167–175. doi:10.1177/0885066613510874. ISSN 1525-1489. PMID 24227448.
^ Li, Bo; Wang, Huixia; Wu, Hui; Gao, Chengjie (2015-04-01). "Neurocognitive dysfunction risk alleviation with the use of dexmedetomidine in perioperative conditions or as ICU sedation: a meta-analysis". Medicine 94 (14): e597. doi:10.1097/MD.0000000000000597. ISSN 1536-5964. PMC 4554047. PMID 25860207.
^ MacLaren, Robert; Preslaski, Candice R.; Mueller, Scott W.; Kiser, Tyree H.; Fish, Douglas N.; Lavelle, James C.; Malkoski, Stephen P. (2015-03-01). "A randomized, double-blind pilot study of dexmedetomidine versus midazolam for intensive care unit sedation: patient recall of their experiences and short-term psychological outcomes". Journal of Intensive Care Medicine 30 (3): 167–175. doi:10.1177/0885066613510874. ISSN 1525-1489. PMID 24227448.
^ Turunen, Heidi; Jakob, Stephan M.; Ruokonen, Esko; Kaukonen, Kirsi-Maija; Sarapohja, Toni; Apajasalo, Marjo; Takala, Jukka (2015-01-01). "Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation". Critical Care (London, England) 19: 67. doi:10.1186/s13054-015-0787-y. ISSN 1466-609X. PMC 4391080. PMID 25887576.
^ Dere, Kamer; Sucullu, Ilker; Budak, Ersel Tan; Yeyen, Suleyman; Filiz, Ali Ilker; Ozkan, Sezai; Dagli, Guner (2010-07-01). "A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation". European Journal of Anaesthesiology 27 (7): 648–652. doi:10.1097/EJA.0b013e3283347bfe. ISSN 1365-2346. PMID 20531094.
^ Paris A, Tonner PH (2005). "Dexmedetomidine in anaesthesia". Current Opinion in Anaesthesiology 18 (4): 412–8. doi:10.1097/01.aco.0000174958.05383.d5. PMID 16534267.
^ Giovannitti, Joseph A.; Thoms, Sean M.; Crawford, James J. (2015-01-01). "Alpha-2 Adrenergic Receptor Agonists: A Review of Current Clinical Applications". Anesthesia Progress 62 (1): 31–38. doi:10.2344/0003-3006-62.1.31. ISSN 0003-3006. PMC 4389556. PMID 25849473.
^ Ahmed, S. S.; Unland, T; Slaven, J. E.; Nitu, M. E.; Rigby, M. R. (2014). "Successful use of intravenous dexmedetomidine for magnetic resonance imaging sedation in autistic children". Southern Medical Journal 107 (9): 559–64. doi:10.14423/SMJ.0000000000000160. PMID 25188619.
^ Menon DV, Wang Z, Fadel PJ, Arbique D, Leonard D, Li JL, Victor RG, Vongpatanasin W (2007). "Central sympatholysis as a novel countermeasure for cocaine-induced sympathetic activation and vasoconstriction in humans". J Am Coll Cardiol 50 (7): 626–33. doi:10.1016/j.jacc.2007.03.060. PMID 17692748.
^ John R. Richards , Timothy E. Albertson , Robert W. Derlet , Richard A. Lange , Kent R. Olson , B. Zane Horowitz (February 2015). "Treatment of toxicity from amphetamines, related derivatives, and analogues: A systematic clinical review.". Drug & Alcohol Dependence. doi:10.1016/j.drugalcdep.2015.01.040.
^ "Dosing Guidelines for Precedex" (PDF). Retrieved 2010-11-21.
^ Ebert, T. J.; Hall, J. E.; Barney, J. A.; Uhrich, T. D.; Colinco, M. D. (2000-08-01). "The effects of increasing plasma concentrations of dexmedetomidine in humans". Anesthesiology 93 (2): 382–394. ISSN 0003-3022. PMID 10910487.
^ ^a ^b Keating, Gillian M. (2015-07-01). "Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting". Drugs 75 (10): 1119–1130. doi:10.1007/s40265-015-0419-5. ISSN 0012-6667. PMID 26063213.
^ Nelson, Laura E.; Lu, Jun; Guo, Tianzhi; Saper, Clifford B.; Franks, Nicholas P.; Maze, Mervyn (2003-02-01). "The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects". Anesthesiology 98 (2): 428–436. ISSN 0003-3022. PMID 12552203.
^ ^a ^b ^c Panzer, Oliver; Moitra, Vivek; Sladen, Robert N. (2009-07-01). "Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists". Critical Care Clinics 25 (3): 451–469, vii. doi:10.1016/j.ccc.2009.04.004. ISSN 1557-8232. PMID 19576524.
^ Huupponen, E.; Maksimow, A.; Lapinlampi, P.; Särkelä, M.; Saastamoinen, A.; Snapir, A.; Scheinin, H.; Scheinin, M.; Meriläinen, P. (2008-02-01). "Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep". Acta Anaesthesiologica Scandinavica 52 (2): 289–294. doi:10.1111/j.1399-6576.2007.01537.x. ISSN 1399-6576. PMID 18005372.
^ "Precedex (Dexmedetomidine hydrochloride) Drug Information: Clinical Pharmacology - Prescribing Information at RxList". RxList. Retrieved 2015-11-16.
^ Shehabi, Yahya; Ruettimann, Urban; Adamson, Harriet; Innes, Richard; Ickeringill, Mathieu (2004-12-01). "Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects". Intensive Care Medicine 30 (12): 2188–2196. doi:10.1007/s00134-004-2417-z. ISSN 0342-4642. PMID 15338124.

External links

Website of Precedex

UpToDate Contents

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1. 小児に対する手術室外での鎮静処置に使用する薬剤 pharmacologic agents for pediatric procedural sedation outside of the operating room
2. 重症患者における鎮静鎮痛剤：特性、投与レジメン、および副作用 sedative analgesic medications in critically ill patients properties dosage regimens and adverse effects
3. 小児に対する手術室外での鎮静処置に使用する薬剤の選択 selection of medications for pediatric procedural sedation outside of the operating room
4. 苦痛緩和のための鎮静 palliative sedation
5. 重症患者における鎮静鎮痛剤：選択、開始、維持、および離脱 sedative analgesic medications in critically ill patients selection initiation maintenance and withdrawal

English Journal

The hemodynamic response to dexmedetomidine loading dose in children with and without pulmonary hypertension.

Friesen RH, Nichols CS, Twite MD, Cardwell KA, Pan Z, Pietra B, Miyamoto SD, Auerbach SR, Darst JR, Ivy DD.SourceDepartment of Anesthesiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave., Aurora, CO 80045. robert.friesen@childrenscolorado.or.
Anesthesia and analgesia.Anesth Analg.2013 Oct;117(4):953-9. doi: 10.1213/ANE.0b013e3182a15aa6. Epub 2013 Aug 19.
BACKGROUND: Dexmedetomidine, an α-2 receptor agonist, is widely used in children with cardiac disease. Significant hemodynamic responses, including systemic and pulmonary vasoconstriction, have been reported after dexmedetomidine administration. Our primary goal of this prospective, observational s
PMID 23960035

Pain, agitation, delirium, and neuromuscular blockade: a review of basic pharmacology, assessment, and monitoring.

Altshuler J, Spoelhof B.SourceDepartment of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, Texas.
Critical care nursing quarterly.Crit Care Nurs Q.2013 Oct-Dec;36(4):356-69. doi: 10.1097/CNQ.0b013e3182a10dbf.
Agitation, pain, and delirium are focal points for targeted pharmacologic therapy in the intensive care unit. Understanding how to treat these essential entities necessitates fundamental understanding of the pharmacology of sedation, analgesia, and antipsychotics. Monitoring the effectiveness of the
PMID 24002426

Suppression of phagosome proteolysis and Matrigel migration with the α2-adrenergic receptor agonist dexmedetomidine in murine dendritic cells.

Ueshima H, Inada T, Shingu K.SourceDepartment of Anesthesiology, Kansai Medical University , Osaka , Japan.
Immunopharmacology and immunotoxicology.Immunopharmacol Immunotoxicol.2013 Oct;35(5):558-66. doi: 10.3109/08923973.2013.822509. Epub 2013 Aug 8.
Abstract Dexmedetomidine is a highly-selective α2-adrenergic receptor agonist used for sedation of critically ill patients in an intensive care setting. Dendritic cells (DCs) in peripheral tissues sense certain foreign antigens and ingest and process them, while migrating to the regional lymph node
PMID 23927488

Japanese Journal

気道管理にデクスメデトミジンとエアウェイスコープが有用であったコルネリア・デランゲ症候群患児の麻酔経験

古屋敦司,鈴木翔,近藤聡子 [他]
麻酔 63(7), 810-813, 2014-07
NAID 40020146872

i-gelの意識下挿入を行った閉塞型睡眠時無呼吸症候群の麻酔経験

松波小百合,駒澤伸泰,葛川洋介 [他]
麻酔 63(7), 807-809, 2014-07
NAID 40020146811

自発呼吸温存下に左上葉のみで分離肺換気を施行した1症例

北埜学,駒澤伸泰,大地史広 [他]
麻酔 63(7), 797-799, 2014-07
NAID 40020146692

Related Pictures

★リンクテーブル★

リンク元	「デクスメデトミジン」
拡張検索	「dexmedetomidine hydrochloride」

「デクスメデトミジン」

Dexmedetomidine
Systematic (IUPAC) name
	(S)-4-[1-(2,3-Dimethylphenyl)ethyl]-3H-imidazole
Clinical data
Trade names	Precedex, Dexdor, Dexdomitor
AHFS/Drugs.com	monograph
Pregnancy; category	US: C (Risk not ruled out); ;
Legal status	US: ℞-only;
Routes of; administration	Intravenous infusion only
Pharmacokinetic data
Protein binding	94%
Metabolism	Near complete hepatic metabolism to inactive metabolites
Biological half-life	2 hours
Excretion	Urinary
Identifiers
CAS Number	113775-47-6
ATC code	N05CM18
PubChem	CID: 68602
IUPHAR/BPS	521
DrugBank	DB00633
ChemSpider	4470605
UNII	67VB76HONO
KEGG	D00514
ChEBI	CHEBI:4466
ChEMBL	CHEMBL778
Chemical data
Formula	C13H16N2
Molecular mass	200.28 g/mol
	SMILES n1cc(nc1)[C@H](c2c(c(ccc2)C)C)C ;
	InChI InChI=1S/C13H16N2/c1-9-5-4-6-12(10(9)2)11(3)13-7-14-8-15-13/h4-8,11H,1-3H3,(H,14,15)/t11-/m0/s1 ; Key:CUHVIMMYOGQXCV-NSHDSACASA-N ;
(verify)

　　[★]

英: dexmedetomidine
化: 塩酸デクスメデトミジン dexmedetomidine hydrochloride
商: プレセデックス Precedex
関: アドレナリン受容体

ICU.782

選択性の高いα2刺激薬
呼吸抑制を生じない静脈内鎮静薬
作用：沈静、抗不安、軽度鎮痛、交感神経遮断作用
作用持続時間：10分以内
人工呼吸からウィーニングする際の鎮静に好適
副作用：低血圧(30%)、徐脈(8%)。離脱後に興奮、交感神経系反跳現象のリスクがある　→　24時間以上投与はやめること

「dexmedetomidine hydrochloride」

　　[★] 塩酸デクスメデトミジン

[Cormack2005-1] Cormack JR, Orme RM, Costello TG (2005). "The role of alpha2-agonists in neurosurgery". Journal of Clinical Neuroscience 12 (4): 375–8. doi:10.1016/j.jocn.2004.06.008. PMID 15925765.

[2] ttp://www.dexdomitor.com/

[:0-3] ttp://orion.fi/en/Research-and-developement/Achievements/

[4] Pasin, Laura; Greco, Teresa; Feltracco, Paolo; Vittorio, Annalisa; Neto, Caetano Nigro; Cabrini, Luca; Landoni, Giovanni; Finco, Gabriele; Zangrillo, Alberto (2013-01-01). "Dexmedetomidine as a sedative agent in critically ill patients: a meta-analysis of randomized controlled trials". PloS One 8 (12): e82913. doi:10.1371/journal.pone.0082913. ISSN 1932-6203. PMC 3877008. PMID 24391726.

[Chen_CD010269-5] Chen, Ken; Lu, Zhijun; Xin, Yi Chun; Cai, Yong; Chen, Yi; Pan, Shu Ming (2015-01-01). "Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients". The Cochrane Database of Systematic Reviews 1: CD010269. ISSN 1469-493X. PMID 25879090.

[6] MacLaren, Robert; Preslaski, Candice R.; Mueller, Scott W.; Kiser, Tyree H.; Fish, Douglas N.; Lavelle, James C.; Malkoski, Stephen P. (2015-03-01). "A randomized, double-blind pilot study of dexmedetomidine versus midazolam for intensive care unit sedation: patient recall of their experiences and short-term psychological outcomes". Journal of Intensive Care Medicine 30 (3): 167–175. doi:10.1177/0885066613510874. ISSN 1525-1489. PMID 24227448.

[7] Li, Bo; Wang, Huixia; Wu, Hui; Gao, Chengjie (2015-04-01). "Neurocognitive dysfunction risk alleviation with the use of dexmedetomidine in perioperative conditions or as ICU sedation: a meta-analysis". Medicine 94 (14): e597. doi:10.1097/MD.0000000000000597. ISSN 1536-5964. PMC 4554047. PMID 25860207.

[8] MacLaren, Robert; Preslaski, Candice R.; Mueller, Scott W.; Kiser, Tyree H.; Fish, Douglas N.; Lavelle, James C.; Malkoski, Stephen P. (2015-03-01). "A randomized, double-blind pilot study of dexmedetomidine versus midazolam for intensive care unit sedation: patient recall of their experiences and short-term psychological outcomes". Journal of Intensive Care Medicine 30 (3): 167–175. doi:10.1177/0885066613510874. ISSN 1525-1489. PMID 24227448.

[9] Turunen, Heidi; Jakob, Stephan M.; Ruokonen, Esko; Kaukonen, Kirsi-Maija; Sarapohja, Toni; Apajasalo, Marjo; Takala, Jukka (2015-01-01). "Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation". Critical Care (London, England) 19: 67. doi:10.1186/s13054-015-0787-y. ISSN 1466-609X. PMC 4391080. PMID 25887576.

[10] Dere, Kamer; Sucullu, Ilker; Budak, Ersel Tan; Yeyen, Suleyman; Filiz, Ali Ilker; Ozkan, Sezai; Dagli, Guner (2010-07-01). "A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation". European Journal of Anaesthesiology 27 (7): 648–652. doi:10.1097/EJA.0b013e3283347bfe. ISSN 1365-2346. PMID 20531094.

[Paris2005-11] Paris A, Tonner PH (2005). "Dexmedetomidine in anaesthesia". Current Opinion in Anaesthesiology 18 (4): 412–8. doi:10.1097/01.aco.0000174958.05383.d5. PMID 16534267.

[12] Giovannitti, Joseph A.; Thoms, Sean M.; Crawford, James J. (2015-01-01). "Alpha-2 Adrenergic Receptor Agonists: A Review of Current Clinical Applications". Anesthesia Progress 62 (1): 31–38. doi:10.2344/0003-3006-62.1.31. ISSN 0003-3006. PMC 4389556. PMID 25849473.

[13] Ahmed, S. S.; Unland, T; Slaven, J. E.; Nitu, M. E.; Rigby, M. R. (2014). "Successful use of intravenous dexmedetomidine for magnetic resonance imaging sedation in autistic children". Southern Medical Journal 107 (9): 559–64. doi:10.14423/SMJ.0000000000000160. PMID 25188619.

[Menon2007-14] Menon DV, Wang Z, Fadel PJ, Arbique D, Leonard D, Li JL, Victor RG, Vongpatanasin W (2007). "Central sympatholysis as a novel countermeasure for cocaine-induced sympathetic activation and vasoconstriction in humans". J Am Coll Cardiol 50 (7): 626–33. doi:10.1016/j.jacc.2007.03.060. PMID 17692748.

[Richards_2015-15] John R. Richards , Timothy E. Albertson , Robert W. Derlet , Richard A. Lange , Kent R. Olson , B. Zane Horowitz (February 2015). "Treatment of toxicity from amphetamines, related derivatives, and analogues: A systematic clinical review.". Drug & Alcohol Dependence. doi:10.1016/j.drugalcdep.2015.01.040.

[Dosing-16] "Dosing Guidelines for Precedex" (PDF). Retrieved 2010-11-21.

[17] Ebert, T. J.; Hall, J. E.; Barney, J. A.; Uhrich, T. D.; Colinco, M. D. (2000-08-01). "The effects of increasing plasma concentrations of dexmedetomidine in humans". Anesthesiology 93 (2): 382–394. ISSN 0003-3022. PMID 10910487.

[Keating_1119.E2.80.931130-18] Keating, Gillian M. (2015-07-01). "Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting". Drugs 75 (10): 1119–1130. doi:10.1007/s40265-015-0419-5. ISSN 0012-6667. PMID 26063213.

[19] Nelson, Laura E.; Lu, Jun; Guo, Tianzhi; Saper, Clifford B.; Franks, Nicholas P.; Maze, Mervyn (2003-02-01). "The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects". Anesthesiology 98 (2): 428–436. ISSN 0003-3022. PMID 12552203.

[Panzer_451.E2.80.93469.2C_vii-20] Panzer, Oliver; Moitra, Vivek; Sladen, Robert N. (2009-07-01). "Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists". Critical Care Clinics 25 (3): 451–469, vii. doi:10.1016/j.ccc.2009.04.004. ISSN 1557-8232. PMID 19576524.

[21] Huupponen, E.; Maksimow, A.; Lapinlampi, P.; Särkelä, M.; Saastamoinen, A.; Snapir, A.; Scheinin, H.; Scheinin, M.; Meriläinen, P. (2008-02-01). "Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep". Acta Anaesthesiologica Scandinavica 52 (2): 289–294. doi:10.1111/j.1399-6576.2007.01537.x. ISSN 1399-6576. PMID 18005372.

[22] "Precedex (Dexmedetomidine hydrochloride) Drug Information: Clinical Pharmacology - Prescribing Information at RxList". RxList. Retrieved 2015-11-16.

[23] Shehabi, Yahya; Ruettimann, Urban; Adamson, Harriet; Innes, Richard; Ickeringill, Mathieu (2004-12-01). "Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects". Intensive Care Medicine 30 (12): 2188–2196. doi:10.1007/s00134-004-2417-z. ISSN 0342-4642. PMID 15338124.

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dexmedetomidine