Caution should be exercised when administering Precedex to patients with advanced heart block and/or severe ventricular dysfunction.1

Because Precedex decreases sympathetic nervous system activity, hypotension and/or bradycardia may be expected to be more pronounced in patients with hypovolemia, diabetes or chronic hypertension, and in the elderly.1

Clinically significant episodes of bradycardia and sinus arrest have been reported with Precedex administration in young, healthy volunteers with high vagal tone or with different routes of administration, including rapid intravenous or bolus administration.1

Clinicians should be prepared to intervene with anticholinergic agents to modify vagal tone. In clinical trials, atropine, glycopyrrolate or ephedrine were effective in the treatment of most episodes of Precedex-induced bradycardia.1

Transient hypertension has been observed primarily during the administration of the Precedex loading dose. Treatment has generally not been necessary, although a reduction in the loading dose infusion rate may be desirable.1