Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Generic: 400 mcg/4 mL (4 mL); 1000 mcg/10 mL (10 mL)
Solution, Intravenous [preservative free]:
Precedex: 400 mcg/100 mL (100 mL); 200 mcg/2 mL (2 mL) [additive free, latex free]
Precedex: 200 mcg/50 mL (50 mL) [latex free]
Precedex: 80 mcg/20 mL (20 mL)
Generic: 80 mcg/20 mL (20 mL); 200 mcg/50 mL (50 mL); 400 mcg/100 mL (100 mL); 200 mcg/2 mL (2 mL); Dexmedetomidine 200 mcg/50 mL in Dextrose 5% (50 mL); Dexmedetomidine 400 mcg/100 mL in Dextrose 5% (100 mL)
Pharmacology
Mechanism of Action
Selective alpha2-adrenoceptor agonist with anesthetic and sedative properties thought to be due to activation of G-proteins by alpha2a-adrenoceptors in the brainstem resulting in inhibition of norepinephrine release; peripheral alpha2b-adrenoceptors are activated at high doses or with rapid IV administration resulting in vasoconstriction.
Pharmacokinetics/Pharmacodynamics
Distribution
Vss:
Preterm Neonates (28 to <36 weeks GA): 2.7 L/kg (range: 2.5 to 5.9 L/kg) (Chrysostomou 2014)
Term Neonates (36 to ≤44 weeks GA): 3.9 L/kg (range: 0.1 to 10.9 L/kg) (Chrysostomou 2014)
Infants and Children <2 years: Median: 3.8 L/kg (range: 1.9 to 4.6 L/kg) (Vilo 2008)
Children 2 to 11 years: Median: 2.2 L/kg (range: 1.3 to 2.8 L/kg) (Vilo 2008)
Adults: ~118 L; rapid
Metabolism
Hepatic via N-glucuronidation, N-methylation, and CYP2A6
Excretion
Urine (95%); feces (4%)
Clearance:
Note: Clearance following cardiac surgery was reduced by 27% in pediatric patients aged 1 week to 14 years (Potts 2009)
Preterm Neonates (28 to <36 weeks GA): 0.3 L/hour/kg (0.2 to 0.4 L/hour/kg) (Chrysostomou 2014)
Term Neonates (36 to ≤44 weeks GA): 0.9 L/hour/kg (0.2 to 1.5 L/hour/kg)
Infants and Children <2 years: Median: 1 L/hour/kg (0.85 to 1.66 L/hour/kg) (Vilo 2008)
Children 2 to 11 years: Median: 1 L/hour/kg (0.56 to 1.35 L/hour/kg) (Vilo 2008)
Adults: ~39 L/hour; Hepatic impairment (Child-Pugh class A, B, or C): Mean clearance values were 74%, 64%, and 53% respectively, of those observed in healthy adults
Onset of Action
IV loading dose: 5 to 10 minutes
Intranasal: 45 to 60 minutes (Yuen 2007), may be faster in pediatric patients when administered via an atomizing device (Talon 2009)
Peak effect:
IV loading dose: 15 to 30 minutes
Intranasal: 90 to 105 minutes (Yuen 2007)
Time to Peak
Serum: Intranasal: Median: 38 minutes (range: 15 to 60 minutes) (Iirola 2011)
Duration of Action
Dose dependent: 60 to 120 minutes
Half-Life Elimination
Preterm Neonates (28 to <36 weeks GA): Terminal: 7.6 hours (range: 3 to 9.1 hours) (Chrysostomou 2014)
Term Neonates (36 to ≤44 weeks GA): Terminal: Median: 3.2 hours (range: 1 to 9.4 hours) (Chrysostomou 2014)
Infants and Children <2 years: Terminal: Median: 2.3 hours (range: 1.5 to 3.3 hours) (Vilo 2008)
Children 2 to 11 years: Terminal: Median: 1.6 hours (range: 1.2 to 2.3 hours) (Vilo 2008)
Adults: Distribution: ~6 minutes; Terminal: ~up to 3 hours (Venn 2002); significantly prolonged in patients with severe hepatic impairment (Cunningham 1999)
Protein Binding
~94%
Use in Specific Populations
Special Populations: Hepatic Function Impairment
Clearance and plasma protein binding are decreased in patients with hepatic impairment.
Use: Labeled Indications
Intensive care unit sedation: Sedation of initially-intubated and mechanically-ventilated patients during treatment in an intensive care setting
Procedural sedation: Procedural sedation prior to and/or during awake fiberoptic intubation; sedation prior to and/or during surgical or other procedures of nonintubated patients
Use: Off Label
Sedation during awake craniotomyb
Data from controlled studies indicate that dexmedetomidine can be used successfully to provide sedation during awake craniotomy and may help reduce length of stay as well as the need for other perioperative pharmacological interventions. Additional trials may be necessary to further define the role of dexmedetomidine in this condition.
Additional Off-Label Uses
Treatment of shivering
Contraindications
There are no contraindications listed in the US manufacturer's labeling.
Canadian labeling: Hypersensitivity to dexmedetomidine or any component of the formulation.
Dosage and Administration
Dosing: Adult
Note: Errors have occurred due to misinterpretation of dosing information. Maintenance dose expressed as mcg/kg/hour. Individualized and titrated to desired clinical effect. At recommended doses, dexmedetomidine does not provide adequate and reliable amnesia (when necessary); therefore, use of additional agents with amnestic properties (eg, benzodiazepines) may be necessary (Ebert 2000).
ICU sedation: IV: Initial: Loading infusion (optional; see "Note" below) of 1 mcg/kg over 10 minutes, followed by a maintenance infusion (see "Note" below) of 0.2 to 0.7 mcg/kg/hour; adjust rate to desired level of sedation; titration no more frequently than every 30 minutes may reduce the incidence of hypotension (Gerlach 2009)
Note: Loading infusion: The loading dose may be omitted for this indication if patient is either being converted from another sedative and patient is adequately sedated or there are concerns for hemodynamic compromise. Maintenance infusion: Dosing ranges between 0.2 to 1.5 mcg/kg/hour have been reported during randomized controlled clinical trials (Pandharipande 2007; Riker 2009). Although infusion rates as high as 2.5 mcg/kg/hour have been used, it is thought that doses >1.5 mcg/kg/hour do not add to clinical efficacy (Venn 2003). Manufacturer recommends duration of infusion should not exceed 24 hours; however, randomized clinical trials have demonstrated efficacy and safety comparable to lorazepam and midazolam with longer-term infusions of up to ~5 days (Pandharipande 2007; Riker 2009).
Procedural sedation: IV: Initial: Loading infusion of 1 mcg/kg (or 0.5 mcg/kg for less invasive procedures [eg, ophthalmic]) over 10 minutes, followed by a maintenance infusion of 0.6 mcg/kg/hour, titrate to desired effect; usual range: 0.2 to 1 mcg/kg/hour
Fiberoptic intubation (awake): IV: Initial: Loading infusion of 1 mcg/kg over 10 minutes, followed by a maintenance infusion of 0.7 mcg/kg/hour until endotracheal tube is secured (Bergese 2010).
Craniotomy (awake) (off-label use): IV: Initial: Loading infusion of 0.5 to 1 mcg/kg over 10 to 20 minutes, followed by a maintenance infusion of 0.5 mcg/kg/hour, titrate to desired effect (Bekker 2001; Bekker, 2008; Piccioni 2008; Shen 2013); usual range: 0.1 to 0.7 mcg/kg/hour (Piccioni 2008)
Dosing: Geriatric
ICU sedation: IV: Refer to adult dosing. Consider dosage reduction. No specific guidelines available. Dose selections should be cautious, at the low end of dosage range; titration should be slower, allowing adequate time to evaluate response.
Procedural sedation: IV: Refer to adult dosing: Initial: Loading infusion of 0.5 mcg/kg over 10 minutes; Maintenance infusion: Dosage reduction should be considered.
Dosing: Pediatric
Note: Errors have occurred due to misinterpretation of dosing information. Maintenance dose expressed as mcg/kg/hour. Individualize and titrate to desired clinical effect. At recommended doses, dexmedetomidine does not provide adequate and reliable amnesia (when necessary); therefore, use of additional agents with amnestic properties (eg, benzodiazepines) may be necessary (Ebert 2000).
ICU sedation: Infants, Children, and Adolescents: Limited data available:
Loading dose (Optional): IV: 0.5 to 1 mcg/kg/dose over 10 minutes (Chrysostomou 2009; Walker 2006); use of loading dose is dependent upon concomitant sedation agents and patient’s current and desired level of sedation
Maintenance dose: Continuous IV infusion: Initial: 0.2 to 0.5 mcg/kg/hour; adjust dose to desired level of sedation. Dosing based on multiple retrospective studies, case reports, and a few prospective studies. Most reported increasing by 0.1 to 0.3 mcg/kg/hour as needed. Reported maintenance dose variable, usual reported range was 0.4 to 0.7 mcg/kg/hour (Bejian 2009; Carroll 2008; Chrysostomou 2006; Chrysostomou 2009; Czaja 2009; Hosokawa 2010; Tobias 2004; Walker 2006; Whalen 2014). In general, infants may require higher maintenance infusion rates than either neonates or older children (Chrysostomou 2006; Chrysostomou 2009; Tobias 2004). Maximum reported doses varied; most utilized doses <1 mcg/kg/hour; however, doses as high as 2.5 mcg/kg/hour in intubated patients have been described (Carroll 2008). Although the manufacturer recommends duration of infusion should not exceed 24 hours, most studies reported use beyond this time period; most patients received infusion for ≤72 hours; however, one patient received dexmedetomidine for 103 days (Whalen 2014). Prolonged infusions should not be abruptly discontinued and are generally tapered over several days to prevent withdrawal symptoms.
Sedation/anesthesia, noninvasive procedures: Limited data available:
Loading dose: Infants, Children, and Adolescents: IV: 0.5 to 2 mcg/kg/dose over 10 minutes; may be repeated if sedation is not adequate (Ahmed 2014; Berkenbosch 2005; Koroglu 2006; Mason 2013; Siddappa 2011)
Maintenance dose: Infants, Children, and Adolescents: Continuous IV infusion: 0.5 to 1 mcg/kg/hour (Ahmed 2014; Berkenbosch 2005; Koroglu 2006; Mason 2013; Siddappa 2011). Dosing based on multiple retrospective and prospective studies in over 800 pediatric patients receiving dexmedetomidine (± other sedatives) for noninvasive procedures (eg, EEG, MRI, PET scan). In the largest, a retrospective study, 669 patients (age: 0.1 to 22.5 years) undergoing nuclear medicine imaging received dexmedetomidine for sedation. A bolus of 2 mcg/kg was administered over 10 minutes; this dose could be repeated up to 2 additional times if the predefined sedation score was not achieved; in addition, patients also received a maintenance infusion of 1 mcg/kg/hour. The mean time to achieve adequate sedation for all patients was 8.6 ± 4.6 minutes (range: 1 to 40 minutes). Hypotension, hypertension, and bradycardia occurred in 58.7%, 2.1% and 4.3% of patients, respectively; no patient required pharmacologic treatment. Hypotension and bradycardia were noted to be age related; risk of hypotension increased by 25% with each 5 year age increment increase and bradycardia occurred more often in children 3 to 12 years than any other age group. The authors concluded that the drug was well tolerated (Mason 2013).
Sedation, pre-anesthetic: Limited data available: Children and Adolescents (very limited data available in patients >9 years): Intranasal: 1 to 2 mcg/kg as a single dose 30 to 60 minutes prior to induction of anesthesia. Higher-end doses (2 mcg/kg) are recommended for older children (≥ 5 years) and adolescents (Talon 2009; Yuen 2012). Dosing based on multiple prospective studies (Akin 2012; Cimen 2013; Talon 2009; Wang 2014; Yuen 2012).
Reconstitution
Concentrated solution (100 mcg/mL): Must dilute in NS to achieve the required concentration (4 mcg/mL) prior to administration. Add 2 mL (200 mcg) of dexmedetomidine to 48 mL of NS for a total volume of 50 mL (4 mcg/mL) or 4 mL (400 mcg) of dexmedetomidine to 96 mL of NS for a total volume of 100 mL. Shake gently to mix.
Administration
Administer using a controlled infusion device. Advisable to use administration components made with synthetic or coated natural rubber gaskets. If loading dose used, administer over 10 minutes; may extend to 20 minutes to further reduce vasoconstrictive effects. Titration no more frequently than every 30 minutes may reduce the incidence of hypotension when used for ICU sedation (Gerlach 2009).
Storage
Bottles: Store at room temperature.
Vials: Store unopened vials (single-dose and multi-dose) at room temperature. Diluted solutions using multi-dose vials may be stored for up to 4 hours at room temperature or up to 24 hours at 2°C to 8°C (35°F to 46°F) prior to use.
Drug Interactions
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Beta-Blockers: Alpha2-Agonists may enhance the AV-blocking effect of Beta-Blockers. Sinus node dysfunction may also be enhanced. Beta-Blockers may enhance the rebound hypertensive effect of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Exceptions: Levobunolol; Metipranolol. Consider therapy modification
Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy
Bradycardia-Causing Agents: May enhance the bradycardic effect of other Bradycardia-Causing Agents. Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Bromperidol: Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. Avoid combination
Ceritinib: Bradycardia-Causing Agents may enhance the bradycardic effect of Ceritinib. Management: If this combination cannot be avoided, monitor patients for evidence of symptomatic bradycardia, and closely monitor blood pressure and heart rate during therapy. Exceptions are discussed in separate monographs. Consider therapy modification
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy
Fexinidazole [INT]: Bradycardia-Causing Agents may enhance the arrhythmogenic effect of Fexinidazole [INT]. Avoid combination
Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy
Ivabradine: Bradycardia-Causing Agents may enhance the bradycardic effect of Ivabradine. Monitor therapy
Lacosamide: Bradycardia-Causing Agents may enhance the AV-blocking effect of Lacosamide. Monitor therapy
Levodopa-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. Monitor therapy
Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Midodrine: May enhance the bradycardic effect of Bradycardia-Causing Agents. Monitor therapy
Mirtazapine: May diminish the antihypertensive effect of Alpha2-Agonists. Management: Consider avoiding concurrent use. If the combination cannot be avoided, monitor for decreased effects of alpha2-agonists if mirtazapine is initiated/dose increased, or increased effects if mirtazapine is discontinued/dose decreased. Consider therapy modification
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Monitor therapy
Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Ruxolitinib: May enhance the bradycardic effect of Bradycardia-Causing Agents. Management: Ruxolitinib Canadian product labeling recommends avoiding use with bradycardia-causing agents to the extent possible. Monitor therapy
Serotonin/Norepinephrine Reuptake Inhibitors: May diminish the antihypertensive effect of Alpha2-Agonists. Monitor therapy
Siponimod: Bradycardia-Causing Agents may enhance the bradycardic effect of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. Consider therapy modification
Terlipressin: May enhance the bradycardic effect of Bradycardia-Causing Agents. Monitor therapy
Tofacitinib: May enhance the bradycardic effect of Bradycardia-Causing Agents. Monitor therapy
Tricyclic Antidepressants: May diminish the antihypertensive effect of Alpha2-Agonists. Management: Consider avoiding this combination. If used, monitor for decreased effects of the alpha2-agonist. Exercise great caution if discontinuing an alpha2-agonist in a patient receiving a TCA. Consider therapy modification
Adverse Reactions
Frequency dependent upon dose, duration, and indication.
>10%:
Cardiovascular: Hypotension (24% to 56%), bradycardia (5% to 42%), systolic hypertension (28%), tachycardia (25%), hypertension (diastolic; 12%), hypertension (11%)
Central nervous system: Agitation (5% to 14%)
Gastrointestinal: Constipation (6% to 14%), nausea (3% to 11%)
Respiratory: Respiratory depression (37%; placebo 32%)
1% to 10%:
Cardiovascular: Atrial fibrillation (2% to 9%), peripheral edema (3% to 7%), hypovolemia (3%), edema (2%)
Central nervous system: Anxiety (5% to 9%)
Endocrine & metabolic: Hypokalemia (9%), hyperglycemia (7%), hypoglycemia (5%), increased thirst (2%), hypocalcemia (1%), hypomagnesemia (1%)
Gastrointestinal: Xerostomia (3% to 4%)
Genitourinary: Oliguria (2%)
Hematologic & oncologic: Anemia (3%)
Renal: Acute renal failure (2% to 3%), decreased urine output (1%)
Respiratory: Respiratory failure (2% to 10%), adult respiratory distress syndrome (1% to 9%), pleural effusion (2%), wheezing (≤1%)
Miscellaneous: Fever (5% to 7%), withdrawal syndrome (ICU sedation; 3% to 5%)
Postmarketing and/or case reports: Abdominal pain, acidosis, apnea, atrioventricular block, bronchospasm, cardiac arrhythmia, cardiac disease, chills, confusion, convulsions, decreased visual acuity, delirium, diaphoresis, diarrhea, dizziness, drug tolerance (use >24 hours), dyspnea, extrasystoles, hallucination, headache, heart block, hemorrhage, hepatic insufficiency, hyperbilirubinemia, hypercapnia, hyperkalemia, hypernatremia, hyperpyrexia, hypoventilation, hypoxia, illusion, increased blood urea nitrogen, increased gamma-glutamyl transferase, increased serum alkaline phosphatase, increased serum ALT, increased serum AST, inversion T-wave on ECG, myocardial infarction, neuralgia, neuritis, pain, photopsia, polyuria, prolonged Q-T interval on ECG, pulmonary congestion, respiratory acidosis, rigors, seizure, sinoatrial arrest, speech disturbance, supraventricular tachycardia, tachyphylaxis (use >24 hours), variable blood pressure, ventricular arrhythmia, ventricular tachycardia, visual disturbance, vomiting
Warnings/Precautions
Concerns related to adverse effects:
- Cardiovascular effects: Episodes of bradycardia, hypotension, and sinus arrest have been associated with rapid IV administration (eg, bolus administration) or when given to patients with high vagal tone. When used for ICU sedation, use of a loading dose is optional; for the maintenance infusion, titration no more frequently than every 30 minutes may reduce the incidence of hypotension (Gerlach 2009). If medical intervention is required, treatment may include stopping or decreasing the infusion, increasing the rate of IV fluid administration, use of pressor agents, and elevation of the lower extremities. At low concentrations, mean arterial pressure (MAP) may be reduced without changes in other hemodynamic parameters (eg, pulmonary artery occlusion pressure [PAOP]); however, at higher concentrations (>1.9 ng/mL), MAP, CVP, PAOP, PVR, and SVR increase (Ebert 2000).
- Transient hypertension: Has been primarily observed during loading dose administration and is associated with the initial peripheral vasoconstrictive effects of dexmedetomidine. Treatment is generally unnecessary; however, reduction of infusion rate may be required.
Disease-related concerns:
- Cardiovascular disease: Use with caution in patients with heart block, bradycardia, severe ventricular dysfunction, hypovolemia, or chronic hypertension. In a scientific statement from the American Heart Association, dexmedetomidine has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: moderate) (AHA [Page 2016]).
- Diabetes: Use with caution in patients with diabetes mellitus; cardiovascular adverse events (eg, bradycardia, hypotension) may be more pronounced.
- Hepatic impairment: Use with caution in patients with hepatic impairment; dosage reductions recommended.
Concurrent drug therapy issues:
- Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
Special populations:
- Elderly: Use with caution in the elderly; cardiovascular events (eg, bradycardia, hypotension) may be more pronounced. Dose reduction may be necessary.
Other warnings/precautions:
- Arousability: Patients may be arousable and alert when stimulated. This alone should not be considered as lack of efficacy in the absence of other clinical signs/symptoms.
- Experienced personnel: Should be administered only by persons skilled in management of patients in intensive care setting or operating room. Patients should be continuously monitored.
- Tolerance and tachyphylaxis: Use of infusions >24 hours has been associated with tolerance and tachyphylaxis and dose-related increase in adverse reactions.
- Withdrawal: When withdrawn abruptly in patients who have received >24 hours of therapy, withdrawal symptoms may result (eg, hypertension, tachycardia, nervousness, nausea, vomiting, agitation, headaches). Use for >24 hours is not recommended by the manufacturer.
Monitoring Parameters
Level of sedation; heart rate, respiration, rhythm, blood pressure; pain control. Note: Dexmedetomidine causes minimal respiratory depression, inhibits salivation, and is analgesic-sparing.
Critically-ill mechanically ventilated ICU patients: Assess and adjust sedation according to scoring system (Richmond Agitation-Sedation Scale [RASS] or Sedation-Agitation Scale [SAS]) (SCCM [Devlin 2018]).
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
Adverse effects have been observed in some animal reproduction studies. Dexmedetomidine is expected to cross the placenta. Information related to use during pregnancy is limited (El-Tahan 2012).
Patient Education
What is this drug used for?
- It is used to cause sleep during a procedure.
Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:
- Severe dizziness
- Passing out
- Trouble breathing
- Slow breathing
- Shallow breathing
- Slow heartbeat
- Fast heartbeat
- Abnormal heartbeat
- Agitation
- Anxiety
- Headache
- Confusion
- Constipation
- Diarrhea
- Salt cravings
- Abdominal pain
- Sweating a lot
- Weakness
- Weight loss
- Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.
Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.
Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.
