Buprenorphine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drug reference
Dexmedetomidine
Selective alpha-2 adrenergic agonist (sedative) · Analgesic
Also known as Dexmedetomidine Hydrochloride, Precedex, Dexem, Dexemine, Dexmed, Dextomid
START
ICU: ±1 mcg/kg load over 10 min, then 0.2–0.7 mcg/kg/h titrated to sedation target
TYPICAL MAX
≤1.5 mcg/kg/h; avoid abrupt cessation after prolonged infusion (taper)
STOP IF
Severe bradycardia/heart block, severe hypotension; taper after prolonged use (withdrawal/rebound HTN)
WATCH
Continuous ECG/BP/HR, sedation depth, withdrawal on weaning (taper), hepatic dose reduction
CDSCO approvedSchedule HATC N05CM18
KDIGO 2024 + manufacturer label
- ONSET
- 10min · onset (~10 min)
- PEAK
- 24min · peak (~25 min)
- t½
- 2h · plasma t½
- DURATION
- 1h · offset after stopping
EXCRETION
Hepatic glucuronidation/CYP; ~95% renal metabolites
route + CYP
INTERACTIONS
6 major
SEVERE in our sources
PREGNANCY
Use only if clearly needed — limited data; potential neonatal effects near delivery
FDA category + note
Top interactionssee all 7 →
- BuprenorphineSevereDatabaseDDInter
- AnaestheticsSevereDatabaseKimi deep-research + Cla
- Beta BlockersSevereDatabaseKimi deep-research + Cla
- DextropropoxypheneSevereDatabaseDDInter
Available in India
15 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Highly selective central alpha-2 agonism (locus coeruleus) producing cooperative/arousable sedation, anxiolysis and analgesia with minimal respiratory depression; sympatholysis → bradycardia/hypotension.
Indications
ICU sedation of intubated/mechanically ventilated patientsProcedural sedation (non-intubated)Adjunct in anaesthesia; (sublingual film) acute agitation in bipolar/schizophrenia
Dosing
- Adult
- ICU: optional loading 1 mcg/kg over 10 min, then 0.2–0.7 mcg/kg/h (up to 1.5) titrated; procedural 0.5–1 mcg/kg over 10 min then 0.2–1 mcg/kg/h. Sublingual film 120–180 mcg agitation.
- Pediatric
- Specialist; weight-based.
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- Reduce dose (hepatic metabolism; accumulation/prolonged sedation).
- Geriatric
- Lower dose; bradycardia/hypotension risk.
- Max dose
- Infusion generally ≤1.5 mcg/kg/h; limit continuous use (typically ≤24 h labelled, often longer in practice)
Pharmacokinetics
Onset
~5–10 min (loading); ~15 min without load
Peak effect
~15–30 min
Duration
Offset within ~30–60 min after stopping
Half-life
~2 h
Bioavailability
IV; sublingual film bioavailable
Protein binding
~94%
Metabolism
Hepatic (glucuronidation + CYP2A6/others)
Excretion
Renal (~95% metabolites) and faecal
Contraindications
- Hypersensitivity to dexmedetomidine
- Caution: advanced heart block/severe bradycardia, severe hypovolaemia/hypotension, hepatic impairment
Side effects
Common
HypotensionBradycardiaDry mouthHypertension (transient, with loading)Nausea
Serious
- Severe bradycardia/sinus arrest, heart block
- Severe hypotension or rebound hypertension on abrupt withdrawal (prolonged use)
- Withdrawal/agitation (prolonged infusion)
- Hyperthermia/QT changes (rare)
Pregnancy & lactation
Pregnancy
Use only if clearly needed — limited data; potential neonatal effects near delivery
Lactation
Limited data; short-term ICU/procedural use — caution
Drug interactions
Anaesthetics
Severe
Database
Additive sedation, hypotension and bradycardia
Reduce co-administered doses; titrate; monitor
Source: Kimi deep-research + Cla
Beta Blockers
Severe
Database
Additive severe bradycardia/AV block
Monitor HR; have atropine/pacing available
Source: Kimi deep-research + Cla
Dextropropoxyphene
Severe
Database
Clinical effect not specified
Source: DDInter
Sodium Oxybate
Severe
Database
Clinical effect not specified
Source: DDInter
Tizanidine
Severe
Database
Clinical effect not specified
Source: DDInter
Digoxin
Moderate
Database
Additive bradycardia
Monitor heart rate
Source: Kimi deep-research + Cla
5 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Ask House about Dexmedetomidine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Katzung, BNF, Nelson·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19