This article was published on Oct 26, 2022.
Dexmedetomidine (US brand name Igalmi™) is an alpha-2 adrenergic receptor agonist approved for the treatment of agitation in schizophrenia or bipolar I or II disorder.
On this page, we will provide basic information about this medication. Links to other articles on this website with more advanced information and tips related to this medication and related topics are provided below—under Related Pages below.
Acute treatment of agitation that is associated with schizophrenia or bipolar I or II disorder in adults.
Mechanism of action/ Pharmacodynamics
Dexmedetomidine is an agonist at presynaptic alpha-2 adrenergic receptors.
The commonest side effects of dexmedetomidine (occurring in 5% or more of patients and at least twice the rate of placebo) were:
– Oral paresthesia/ hypoesthesia
– Dry mouth
– Dizziness, hypotension, orthostatic hypotension.
Warnings and Precautions
a) Avoid use in patients with hypotension, orthostatic hypotension, advanced heart block, severe ventricular dysfunction, or a history of syncope.
b) Avoid use in patients at risk of prolonged QT interval since dexmedetomidine may prolong QT interval.
c) May cause dizziness. Patients should be asked to take precautions while driving or operating machinery.
Dosage and Administration
Dexmedetomidine is administered sublingually or buccally under the supervision of a healthcare provider. The provider monitors the vital signs and alertness of the patient to prevent falls and syncope.
Preparation of the dosage:
Depending on the dosage prescribed, the healthcare provider may open the foil pouch and either:
a) Give the pouch to the patient to administer the full dosage contained in the pouch, or
b) Cut the film in half with scissors and give half dosage to the patient. The other half of the film may be discarded.
Instruct the patient to place the film under the tongue. Instruct the patient not to eat or drink 15 minutes after sublingual administration.
Instruct the patient to place the film behind the lower lip. The patient should not eat or drink one hour after buccal administration.
Ask the patient to close the mouth and let the film dissolve. The patient should not chew or swallow the film.
Dosage in adults
Mild or moderate agitation: 120 mcg
Severe agitation: 180 mcg
Dosage in mild or moderate hepatic impairment
Mild or moderate agitation: 90 mcg
Severe agitation: 120 mcg
Dosage in severe hepatic impairment
Mild or moderate agitation: 60 mcg
Severe agitation: 90 mcg
Dosage in elderly patients (>65 years)
Mild, moderate, or severe agitation: 120 mcg
Dosage forms and strengths
Sublingual film: 120 mcg and 180 mcg
Important! This page does not provide all the information needed to prescribe this medication. Please refer to the full Prescribing Information (see the link below) before prescribing this medication.
Agitation: General articles
An overview of agitation and aggressiveness in mental health settings
Safety first! Preventing injury due to violence by patients
Advanced tips for verbal de-escalation of agitated/ aggressive patients
When calm needs to be injected: Intramuscular and intravenous injections for agitation or aggressiveness
How to manage agitation in a pregnant woman
Dexmedetomidine (Igalmi™): Basic information
Agitation in autism spectrum disorder
Autism spectrum disorder: Evaluation of irritability, agitation, aggressive behavior
Autism spectrum disorder: Medications to treat irritability, agitation, or aggressive behavior
Agitation in dementia
Key points from the APA Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia
Citalopram for agitation in Alzheimer’s disease
Case: Agitation in a patient with Alzheimer’s disease
Dexmedetomidine (Igalmi™) Prescribing information
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