{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T20:18:16Z","timestamp":1767125896588,"version":"3.48.0"},"reference-count":36,"publisher":"The Pediatric Pharmacy Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    Dexmedetomidine is a centrally acting selective \u03b1\n                    <jats:sub>2<\/jats:sub>\n                    -adrenergic agonist that initially received US Food and Drug Administration approval in 1999 for the sedation of intubated and mechanically ventilated adult patients for up to 24 hours. Since then, it has seen widespread use in clinical practice in various clinical scenarios including sedation during mechanical ventilation, provision of adjunctive analgesia, procedural sedation, treatment of withdrawal, and sedation during end-of-life care. Although traditionally administered intravenously, animal investigations and anecdotal clinical experience has reported efficacy with subcutaneous (SC) administration. Clinical applications of SC dexmedetomidine have included procedural sedation; outpatient and home care where IV administration may not be feasible or interfere with patient comfort; the management or prevention of drug withdrawal symptoms; and during end-of-life care. This educational review outlines the basic physiology of dexmedetomidine, and details reports of its SC administration in laboratory animals as well as various clinical scenarios with a specific focus on its applications in pediatric-aged patients. Techniques for SC administration and dosing schemes are presented.\n                  <\/jats:p>","DOI":"10.5863\/jppt-25-00008","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T15:57:30Z","timestamp":1765814250000},"page":"744-751","source":"Crossref","is-referenced-by-count":0,"title":["Investigation and Clinical Experience With Subcutaneous Dexmedetomidine: An Educational Focused Review With a Focus on Pediatric-Aged Patients"],"prefix":"10.5863","volume":"30","author":[{"given":"Mitchell","family":"Hughes","sequence":"first","affiliation":[{"name":"Heritage College of Osteopathic Medicine\u2013Dublin Campus (MH), Dublin, Ohio and Ohio University, Athens, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph D.","family":"Tobias","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology & Pain Medicine (JDT), Nationwide Children\u2019s Hospital and the Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"issue":"1","key":"JPPT-25-00008-b01","series-title":"J Pediatr Pharmacol Ther","first-page":"17","article-title":"Dexmedetomidine use in pediatric intensive care and procedural sedation","volume":"15","author":"Buck","year":"2010","unstructured":"Buck ML. Dexmedetomidine use in pediatric intensive care and procedural sedation. J Pediatr Pharmacol Ther. 2010;15(1):17\u201329."},{"key":"JPPT-25-00008-b02","series-title":"Pediatr Crit Care Med","first-page":"115","article-title":"Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology","volume":"8","author":"Tobias","year":"2007","unstructured":"Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 2007;8:115\u2013131."},{"issue":"10","key":"JPPT-25-00008-b03","series-title":"BJA Educ","first-page":"348","article-title":"Dexmedetomidine in paediatric anaesthesia","volume":"20","author":"Lin","year":"2020","unstructured":"Lin R, Ansermino JM. Dexmedetomidine in paediatric anaesthesia. BJA Educ. 2020;20(10):348\u2013353."},{"key":"JPPT-25-00008-b04","series-title":"Paediatr Anaesth","first-page":"171","article-title":"Initial experience with dexmedetomidine in pediatric-aged patients","volume":"12","author":"Tobias","year":"2002","unstructured":"Tobias JD, Berkenbosch JW. Initial experience with dexmedetomidine in pediatric-aged patients. Paediatr Anaesth. 2002;12:171\u2013175."},{"key":"JPPT-25-00008-b05","series-title":"South Med J","first-page":"871","article-title":"Additional experience with dexmedetomidine in pediatric-aged patients","volume":"96","author":"Tobias","year":"2003","unstructured":"Tobias JD, Berkenbosch JW, Russo P. Additional experience with dexmedetomidine in pediatric-aged patients. South Med J. 2003;96:871\u2013875."},{"issue":"9","key":"JPPT-25-00008-b06","series-title":"PLoS One","first-page":"e0292016","article-title":"Dexmedetomidine use for patients in palliative care with intractable pain and delirium: a retrospective study","volume":"18","author":"Yu","year":"2023","unstructured":"Yu SY, Schellenberg J, Alleyne A. Dexmedetomidine use for patients in palliative care with intractable pain and delirium: a retrospective study. PLoS One. 2023;18(9):e0292016."},{"issue":"7","key":"JPPT-25-00008-b07","series-title":"J Pediatr Pharmacol Ther","first-page":"587","article-title":"Applications of dexmedetomidine in palliative and hospice care","volume":"27","author":"Lemus","year":"2022","unstructured":"Lemus R, Jacobowski NL, Humphrey L, Tobias JD. Applications of dexmedetomidine in palliative and hospice care. J Pediatr Pharmacol Ther. 2022;27(7):587\u2013594."},{"key":"JPPT-25-00008-b08","series-title":"J Opioid Manage","first-page":"187","article-title":"Subcutaneous dexmedetomidine infusions to treat or prevent drug withdrawal in infants and children","volume":"4","author":"Tobias","year":"2008","unstructured":"Tobias JD. Subcutaneous dexmedetomidine infusions to treat or prevent drug withdrawal in infants and children. J Opioid Manage. 2008;4:187\u2013191."},{"issue":"8","key":"JPPT-25-00008-b09","series-title":"Eur J Clin Pharmacol","first-page":"1047","article-title":"Subcutaneously administered dexmedetomidine is efficiently absorbed and is associated with attenuated cardiovascular effects in healthy volunteers","volume":"74","author":"Uusalo","year":"2018","unstructured":"Uusalo P, Al-Ramahi D, Tilli I, et al. Subcutaneously administered dexmedetomidine is efficiently absorbed and is associated with attenuated cardiovascular effects in healthy volunteers. Eur J Clin Pharmacol. 2018;74(8):1047\u20131054."},{"issue":"4","key":"JPPT-25-00008-b10","series-title":"J Vet Pharmacol Ther","first-page":"533","article-title":"Pharmacokinetics and pharmacodynamics of intravenous continuous rate infusion and repeated intramuscular administration of dexmedetomidine in standing horses","volume":"44","author":"Shane","year":"2021","unstructured":"Shane SE, Langston VC, Wills RW, et al. Pharmacokinetics and pharmacodynamics of intravenous continuous rate infusion and repeated intramuscular administration of dexmedetomidine in standing horses. J Vet Pharmacol Ther. 2021;44(4):533\u2013543."},{"issue":"1","key":"JPPT-25-00008-b11","series-title":"BMC Vet Res","first-page":"269","article-title":"Use of dexmedetomidine repeated subcutaneous administration for balanced anaesthesia in horses","volume":"18","author":"Rabbogliatti","year":"2022","unstructured":"Rabbogliatti V, Amari M, Brioschi FA, et al. Use of dexmedetomidine repeated subcutaneous administration for balanced anaesthesia in horses. BMC Vet Res. 2022;18(1):269."},{"issue":"1","key":"JPPT-25-00008-b12","series-title":"BMC Vet Res","first-page":"264","article-title":"Pharmacokinetics of dexmedetomidine in anaesthetized horses following repeated subcutaneous administration and intravenous constant rate infusion","volume":"19","author":"Di Cesare","year":"2023","unstructured":"Di Cesare F, Rabbogliatti V, Draghi S, et al. Pharmacokinetics of dexmedetomidine in anaesthetized horses following repeated subcutaneous administration and intravenous constant rate infusion. BMC Vet Res. 2023;19(1):264."},{"issue":"1","key":"JPPT-25-00008-b13","series-title":"Rev Mex Anest","first-page":"16","article-title":"Subcutaneous dexmedetomidine. Is it useful in the perioperative of the pediatric patient?","volume":"43","author":"\u00c1lvarez-Betancourt","year":"2020","unstructured":"\u00c1lvarez-Betancourt AE, S\u00e1nchez-Hern\u00e1ndez E, L\u00f3pez-Gonz\u00e1lez BG, Rodr\u00edguez-Moreno \u00d3A. Subcutaneous dexmedetomidine. Is it useful in the perioperative of the pediatric patient?. Rev Mex Anest. 2020;43(1):16\u201322."},{"key":"JPPT-25-00008-b14","series-title":"Local Reg Anesth","first-page":"29","article-title":"Comparison of subcutaneous dexmedetomidine versus clonidine as an adjuvant to spinal anesthesia: a randomized double blind control trial","volume":"12","author":"Srinivas","year":"2019","unstructured":"Srinivas DB, Lakshminarasimhaiah G. Comparison of subcutaneous dexmedetomidine versus clonidine as an adjuvant to spinal anesthesia: a randomized double blind control trial. Local Reg Anesth. 2019;12:29\u201336."},{"issue":"11","key":"JPPT-25-00008-b15","series-title":"Clin Pharmacokinet","first-page":"1467","article-title":"Population modelling of dexmedetomidine pharmacokinetics and haemodynamic effects after intravenous and subcutaneous administration","volume":"59","author":"Ashraf","year":"2020","unstructured":"Ashraf MW, Uusalo P, Scheinin M, Saari TI. Population modelling of dexmedetomidine pharmacokinetics and haemodynamic effects after intravenous and subcutaneous administration. Clin Pharmacokinet. 2020;59(11):1467\u20131482."},{"issue":"3","key":"JPPT-25-00008-b16","series-title":"Palliat Med","first-page":"278","article-title":"A case report of dexmedetomidine used to treat intractable pain and delirium in a tertiary palliative care unit","volume":"29","author":"Hilliard","year":"2015","unstructured":"Hilliard N, Brown S, Mitchinson S. A case report of dexmedetomidine used to treat intractable pain and delirium in a tertiary palliative care unit. Palliat Med. 2015;29(3):278\u2013281."},{"issue":"1","key":"JPPT-25-00008-b17","series-title":"BMJ Support Palliat Care","first-page":"7","article-title":"Subcutaneous dexmedetomidine for baclofen withdrawal during palliative sedation","volume":"10","author":"Laroche","year":"2020","unstructured":"Laroche JP. Subcutaneous dexmedetomidine for baclofen withdrawal during palliative sedation. BMJ Support Palliat Care. 2020;10(1):7\u20139."},{"issue":"10","key":"JPPT-25-00008-b18","series-title":"Crit Care Med","first-page":"2262","article-title":"Subcutaneous administration of fentanyl and midazolam to prevent withdrawal after prolonged sedation in children","volume":"27","author":"Tobias","year":"1999","unstructured":"Tobias JD. Subcutaneous administration of fentanyl and midazolam to prevent withdrawal after prolonged sedation in children. 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Additional experience with dexmedetomidine in pediatric-aged patients. South Med J. 2003;96:871\u2013875."},{"issue":"9","key":"JPPT-25-00008-b06","series-title":"PLoS One","first-page":"e0292016","article-title":"Dexmedetomidine use for patients in palliative care with intractable pain and delirium: a retrospective study","volume":"18","author":"Yu","year":"2023","unstructured":"Yu SY, Schellenberg J, Alleyne A. Dexmedetomidine use for patients in palliative care with intractable pain and delirium: a retrospective study. PLoS One. 2023;18(9):e0292016."},{"issue":"7","key":"JPPT-25-00008-b07","series-title":"J Pediatr Pharmacol Ther","first-page":"587","article-title":"Applications of dexmedetomidine in palliative and hospice care","volume":"27","author":"Lemus","year":"2022","unstructured":"Lemus R, Jacobowski NL, Humphrey L, Tobias JD. Applications of dexmedetomidine in palliative and hospice care. J Pediatr Pharmacol Ther. 2022;27(7):587\u2013594."},{"key":"JPPT-25-00008-b08","series-title":"J Opioid Manage","first-page":"187","article-title":"Subcutaneous dexmedetomidine infusions to treat or prevent drug withdrawal in infants and children","volume":"4","author":"Tobias","year":"2008","unstructured":"Tobias JD. Subcutaneous dexmedetomidine infusions to treat or prevent drug withdrawal in infants and children. J Opioid Manage. 2008;4:187\u2013191."},{"issue":"8","key":"JPPT-25-00008-b09","series-title":"Eur J Clin Pharmacol","first-page":"1047","article-title":"Subcutaneously administered dexmedetomidine is efficiently absorbed and is associated with attenuated cardiovascular effects in healthy volunteers","volume":"74","author":"Uusalo","year":"2018","unstructured":"Uusalo P, Al-Ramahi D, Tilli I, et al. Subcutaneously administered dexmedetomidine is efficiently absorbed and is associated with attenuated cardiovascular effects in healthy volunteers. Eur J Clin Pharmacol. 2018;74(8):1047\u20131054."},{"issue":"4","key":"JPPT-25-00008-b10","series-title":"J Vet Pharmacol Ther","first-page":"533","article-title":"Pharmacokinetics and pharmacodynamics of intravenous continuous rate infusion and repeated intramuscular administration of dexmedetomidine in standing horses","volume":"44","author":"Shane","year":"2021","unstructured":"Shane SE, Langston VC, Wills RW, et al. Pharmacokinetics and pharmacodynamics of intravenous continuous rate infusion and repeated intramuscular administration of dexmedetomidine in standing horses. J Vet Pharmacol Ther. 2021;44(4):533\u2013543."},{"issue":"1","key":"JPPT-25-00008-b11","series-title":"BMC Vet Res","first-page":"269","article-title":"Use of dexmedetomidine repeated subcutaneous administration for balanced anaesthesia in horses","volume":"18","author":"Rabbogliatti","year":"2022","unstructured":"Rabbogliatti V, Amari M, Brioschi FA, et al. Use of dexmedetomidine repeated subcutaneous administration for balanced anaesthesia in horses. BMC Vet Res. 2022;18(1):269."},{"issue":"1","key":"JPPT-25-00008-b12","series-title":"BMC Vet Res","first-page":"264","article-title":"Pharmacokinetics of dexmedetomidine in anaesthetized horses following repeated subcutaneous administration and intravenous constant rate infusion","volume":"19","author":"Di Cesare","year":"2023","unstructured":"Di Cesare F, Rabbogliatti V, Draghi S, et al. Pharmacokinetics of dexmedetomidine in anaesthetized horses following repeated subcutaneous administration and intravenous constant rate infusion. BMC Vet Res. 2023;19(1):264."},{"issue":"1","key":"JPPT-25-00008-b13","series-title":"Rev Mex Anest","first-page":"16","article-title":"Subcutaneous dexmedetomidine. Is it useful in the perioperative of the pediatric patient?","volume":"43","author":"\u00c1lvarez-Betancourt","year":"2020","unstructured":"\u00c1lvarez-Betancourt AE, S\u00e1nchez-Hern\u00e1ndez E, L\u00f3pez-Gonz\u00e1lez BG, Rodr\u00edguez-Moreno \u00d3A. Subcutaneous dexmedetomidine. Is it useful in the perioperative of the pediatric patient?. Rev Mex Anest. 2020;43(1):16\u201322."},{"key":"JPPT-25-00008-b14","series-title":"Local Reg Anesth","first-page":"29","article-title":"Comparison of subcutaneous dexmedetomidine versus clonidine as an adjuvant to spinal anesthesia: a randomized double blind control trial","volume":"12","author":"Srinivas","year":"2019","unstructured":"Srinivas DB, Lakshminarasimhaiah G. Comparison of subcutaneous dexmedetomidine versus clonidine as an adjuvant to spinal anesthesia: a randomized double blind control trial. Local Reg Anesth. 2019;12:29\u201336."},{"issue":"11","key":"JPPT-25-00008-b15","series-title":"Clin Pharmacokinet","first-page":"1467","article-title":"Population modelling of dexmedetomidine pharmacokinetics and haemodynamic effects after intravenous and subcutaneous administration","volume":"59","author":"Ashraf","year":"2020","unstructured":"Ashraf MW, Uusalo P, Scheinin M, Saari TI. Population modelling of dexmedetomidine pharmacokinetics and haemodynamic effects after intravenous and subcutaneous administration. Clin Pharmacokinet. 2020;59(11):1467\u20131482."},{"issue":"3","key":"JPPT-25-00008-b16","series-title":"Palliat Med","first-page":"278","article-title":"A case report of dexmedetomidine used to treat intractable pain and delirium in a tertiary palliative care unit","volume":"29","author":"Hilliard","year":"2015","unstructured":"Hilliard N, Brown S, Mitchinson S. A case report of dexmedetomidine used to treat intractable pain and delirium in a tertiary palliative care unit. Palliat Med. 2015;29(3):278\u2013281."},{"issue":"1","key":"JPPT-25-00008-b17","series-title":"BMJ Support Palliat Care","first-page":"7","article-title":"Subcutaneous dexmedetomidine for baclofen withdrawal during palliative sedation","volume":"10","author":"Laroche","year":"2020","unstructured":"Laroche JP. Subcutaneous dexmedetomidine for baclofen withdrawal during palliative sedation. BMJ Support Palliat Care. 2020;10(1):7\u20139."},{"issue":"10","key":"JPPT-25-00008-b18","series-title":"Crit Care Med","first-page":"2262","article-title":"Subcutaneous administration of fentanyl and midazolam to prevent withdrawal after prolonged sedation in children","volume":"27","author":"Tobias","year":"1999","unstructured":"Tobias JD. Subcutaneous administration of fentanyl and midazolam to prevent withdrawal after prolonged sedation in children. 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