Any reason why an ICU pt is on precedex rather than propofol?

Omegadramon

10+ Year Member
May 16, 2007
298
0
Atlanta
Status
Pharmacy Student
A quick google search tells me that precedex doesn't cause respiratory depression or requires the constant attention of propofol and it's good for extubation (but what do I know, I'm just a brownnosing p1).

On the other hand, everytime we have a patient on it, I've got to keep on making iv bags for them every 2-3 hrs (This week it was few pts on 400mcg/200ml ns and 800mcg/400ml ns). I dunno, it seems inefficient or maybe those folks are complicated. I'm sure it costs a boatload (but then again, we carry only diprivan on formulary...isn't prop generic?...we must get some sort of bargain...)

I wonder what the anesthesia forums say about this....
 
Last edited:

Priapism321

Bursting with enthusiasm
10+ Year Member
5+ Year Member
Apr 17, 2007
1,424
3
Status
Pharmacist
No good evidence for dexmedetomidine in ICU sedation. Awake intubations, perhaps. Planned extubation within the next 24 hours, maybe.

10 times as expensive as propofol.
 

Priapism321

Bursting with enthusiasm
10+ Year Member
5+ Year Member
Apr 17, 2007
1,424
3
Status
Pharmacist
Oh, and 38 times the cost of midazolam, since it represents the drug class of choice for ICU sedation.
 
About the Ads

Omegadramon

10+ Year Member
May 16, 2007
298
0
Atlanta
Status
Pharmacy Student
Well if doesn't have any advantage in ICU sedation, does it justify its cost in cardiac cases or other procedures?
 

Priapism321

Bursting with enthusiasm
10+ Year Member
5+ Year Member
Apr 17, 2007
1,424
3
Status
Pharmacist
Well if doesn't have any advantage in ICU sedation, does it justify its cost in cardiac cases or other procedures?
Doesn't have evidence to support its use in anything in my opinion, but may be rational for awake/non-intubated ventriculostomy placements, awake intubations, or weaning an agitated patient off a ventilator (12 - 24 hours maximum).
 

Omegadramon

10+ Year Member
May 16, 2007
298
0
Atlanta
Status
Pharmacy Student
Well, thanks for the info. It seems like the folks in my hospital don't care about its cost...we now order it in cases of 25 and we've been handing it out like candy recently.
 

ItsOverZyvox

Retired
Removed
10+ Year Member
Jul 5, 2008
2,281
3
Status
Good Ole Dex... before Dexmedetomidine came on board, clonidine was used in its place in cardiac surgeries. Dex, an Alpha 2 agonist does provide antihypertensive (after a brief period of refractory hypertension)and bradycardic effects which can be beneficial. Also, it does provide effective sedation and a decreased need for opioids which can be beneficial in respiration. And for neuro surgery that requires arousable sedation, Precedex can be preferred over other anesthetic agents.

Nurses love it because it's easier to arouse the patient for scheduled assessment while patient is on Prededex over Propofol.

But yes, Precedex is about 10 times the cost of Propofol. Brand diprivan can actually cost less than generic propofol with the right contract.

So how should we propose we use Propofol over Precedex?
 

ItsOverZyvox

Retired
Removed
10+ Year Member
Jul 5, 2008
2,281
3
Status
Well, thanks for the info. It seems like the folks in my hospital don't care about its cost...we now order it in cases of 25 and we've been handing it out like candy recently.
Your DOP may not care about it but I promise you your administration does.
 

Omegadramon

10+ Year Member
May 16, 2007
298
0
Atlanta
Status
Pharmacy Student
I may be exaggerating it's use based on a few days working. We had next to nobody on TPNs, so I had time to pay attention to orders I was making.

We make sure we put propofol everywhere. Anesthesia carts, heart carts, override access in pyxis in every ICU.

Might have to start putting some next to the coffee pots....
 

bigpharmD

10+ Year Member
Aug 25, 2007
744
2
Sunny
Status
Pre-Optometry
Doesn't have evidence to support its use in anything in my opinion, but may be rational for awake/non-intubated ventriculostomy placements, awake intubations, or weaning an agitated patient off a ventilator (12 - 24 hours maximum).
They could be trying to give their anesthesia residents experience using the drug.....well at least that is an excuse I have heard before...:cool:
 

wee eng

SDN Lifetime Donor
Lifetime Donor
May 8, 2014
6
3
Status
Attending Physician
Long term propofol infusions may lead to Propofol Infusion Syndrome (PRIS) which can be devastating or fatal. Midazolam and other benzodiazepines should be used with caution in older patients. Many anesthesiologists omit midazolam for patients over 70 due to concerns over cognitive dysfunction post treatment. Studies show dexmetetomidine to be equal to propofol or midazolam for sedation in the ICU. Dex also has the feature of better rousability, which may or may not be a concern. Cost is certainly one issue, but should always be considered in the context of cost-benefit. Treatment should always be individualized for the patient.
 

SELDANE

10+ Year Member
Feb 3, 2007
221
90
Status
Non-Student
I don't mean to be so jaded but maybe the drug rep pushing Precedex in your neck of the woods has a million dollar smile and a body that won't quit.
 
About the Ads