Usual Adult Dose for Sedation

Intensive Care Unit Sedation:

• Initial Dose: Loading dose of 1 mcg/kg IV infusion over 10 minutes.
• Maintenance Dose: 0.2 to 0.7 mcg/kg/hour IV infusion; adjust the infusion rate to achieve the desired clinical effect.

Procedural Sedation:

• Initial Dose (including Awake Fiberoptic Intubation): 1 mcg/kg IV infusion over 10 minutes.
• Maintenance Dose: Initiate IV infusion at 0.6 mcg/kg/hour and titrate to achieve the desired clinical effect; doses may range from 0.2 to 1 mcg/kg/hour.

Uses: Sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting; sedation of non-intubated patients prior to and/or during surgical and other procedures.

Usual Geriatric Dose for Sedation

Over Age 65 Years:
Intensive Care Unit Sedation: Dose reduction may be required; however, no specific guidelines have been suggested.

Procedural Sedation:

• Initial Dose: May be omitted or reduced (e.g., 0.5 mcg/kg IV infusion over 10 minutes).
• Maintenance Dose: Dose reduction may be required; however, no specific guidelines have been suggested.

Uses: Sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting; sedation of non-intubated patients prior to and/or during surgical and other procedures.

Renal Dose Adjustments

Data not available.

Liver Dose Adjustments

Dose reduction may be required; however, no specific guidelines have been suggested.

Dose Adjustments

• Intensive Care Unit Sedation: A loading dose may not be required for patients being converted from alternate sedative therapy.
• Procedural Sedation Initial Dose: 0.5 mcg/kg IV infusion given over 10 minutes may be suitable for less invasive procedures (e.g., ophthalmic surgery).
• Maintenance Dose for Awake Fiberoptic Intubation: 0.7 mcg/kg/hour IV infusion until the endotracheal tube is secured.
• Concomitant Use with other Anesthetics, Sedatives, Hypnotics, or Opioids: Dose reduction may be required; however, no specific guidelines have been suggested.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available.

Other Comments

Administration Advice:

• Individualize dosing.
• Administer using a controlled infusion device.
• Administration by continuous infusion should not exceed 24 hours.
• Perform regular assessments if this drug is used for more than 14 days.
• Consider lubricating patients' eyes during drug administration to avoid corneal dryness caused by drug-related lacrimation reduction.
• It is not necessary to discontinue this drug prior to extubation.
• Use administration components made with synthetic or coated natural rubber gaskets since there is potential for absorption of this drug to some types of natural rubber.

Reconstitution/Preparation Techniques:

• Consult the manufacturer product information.

IV Compatibility:

• Consult the manufacturer product information.

General:

• In addition to its sedative effects, this drug has a sympatholytic effect, analgesic and anesthetic/analgesic-sparing effects.
• Avoid using this drug as an induction agent for intubation or for sedation during muscle relaxant use.
• Avoid using this drug for obstetrics, including caesarean section deliveries, as the safety of this drug in labor and delivery has not been studied.
• This drug is not suitable in patients who require continuous deep sedation or with severe cardiovascular instability.
• This drug has not been shown to be amnestic.

Monitoring:

• Continuously monitor ECG, blood pressure, heart rate, and oxygen saturation levels during infusion and afterwards as clinically appropriate.