Dexmedetomidine (Precedex) is a selective alpha-2 agonist I frequently use as a cardiac anesthesiologist and intensivist to provide analgosedation before extubation. Beyond its sedative and sympatholytic effects, dexmedetomidine has been increasingly implicated in drug-induced fever.
Although listed in the FDA label, recent literature provides a clearer picture. A post hoc analysis of 703 ventilated ICU patients found significantly more fevers in the dexmedetomidine group: 43.3% had temperatures ≥38.3°C, and 19.4% reached ≥39.0°C. Interestingly, temperature increased by ~0.3°C for every additional 1 μg/kg/hr infused, suggesting a dose-response relationship.
A systematic review of 17 studies further supported this association, with a median Naranjo score of 4 (probable adverse drug reaction). The case series reported fever onset within 6 hours of starting the infusion and resolution within 3 hours of stopping it. Retrospective data point to increased risk in post-cardiac surgery patients and those with obesity.
In a febrile ICU patient, the default is to assume infection, triggering a cascade of orders – cultures, imaging, antibiotics, etc. It’s important to recognize drug fevers such as those caused by dexmedetomidine as a culprit. If clinically feasible, weaning the medication can offer diagnostic clarity when trying to identify dexmedetomidine as the cause.
Some references include PMIDs: 29137584, 28763361, 33554338, and 33729724
Yes sorry, I should have been more specific. For alcohol withdrawal along with giving benzos.
What is your opinion about using this medication for detox?
As in like alcohol withdrawal? I think it’s a good choice to control the sympathomimetic effects, but you still need something to control the actual withdrawal. Personally, I’m a fan of phenobarbital, but benzodiazepines like lorazepam and chlordiazepoxide are often used as part of CIWA scales.