Dexmedetomidine offers several important advantages for weaning patients off mechanical ventilation in the ICU.

But whether the drug is a clear-cut front-runner for these patients—particularly the 15% who prove resistant to such weaning—needs further study, Gilles L. Fraser, PharmD, MCCM, noted during the 2018 annual congress of the Society of Critical Care Medicine (SCCM).

Dexmedetomidine offers theoretical advantages in this setting, said Dr. Fraser, a critical care pharmacist at the Maine Medical Center, in Portland. For example, it “offers anxiolysis, some morphine-sparing properties, and it does not interfere with respiratory drive.”

But dex also has disadvantages, Dr. Fraser explained, such as hemodynamic derangement, and what he called “econotoxicity”—that is, a much higher cost than the other two frequently used choices, benzodiazepines and propofol. The daily acquisition cost is $40 for a benzodiazepine, $120 for propofol and $500 for dexmedetomidine, he noted.