This product should only be administered by professionals under conditions where medical monitoring equipment is available. Due to the known pharmacologic effects of this product, patients should be continuously monitored while infusing this product. Hypotension, Bradycardia, and Sinus Arrest Clinically significant bradycardia and sinus arrest have been reported in healthy young volunteers with high vagal tone or different modes of administration (e.g., rapid intravenous or push) of this product. Hypotension and bradycardia have been reported in association with infusion of this product. If medical rescue is required, treatment may include reducing or discontinuing the infusion of this product, increasing the flow rate of intravenous fluids, elevating the lower extremities, and administering medications that elevate blood pressure. Because this product has the potential to exacerbate bradycardia caused by vagal stimulation, clinicians should be prepared to intervene. Intravenous administration of anticholinergic agents (e.g., glonium bromide, atropine) should be considered to reduce vagal tone. In clinical trials, atropine or gronethium bromide were effective in the treatment of most bradycardia events caused by this product. However, in some patients with significant cardiovascular dysfunction, further resuscitation is required. Caution should be exercised when administering this product to patients with advanced heart block and/or severe ventricular insufficiency. Because this product reduces sympathetic nervous system activity, more hypotension and/or bradycardia may be expected in patients with hypovolemia, diabetes mellitus or chronic hypertension, and in elderly patients. When other vasodilators or negative frequency-acting drugs are given, concomitant administration of this product may have additive pharmacodynamic effects and should be administered with caution. Transient Hypertension The occurrence of transient hypertension has been observed primarily during loading doses and is related to the peripheral vasoconstrictive effects of this product. Transient hypertension usually does not require treatment, however a reduction in the loading infusion rate may be desirable. Arousal Some patients given this product are observed to be aroused and alert when stimulated. In the absence of other clinical signs and symptoms, this alone should not be considered evidence of lack of efficacy. Withdrawal Symptoms Sedation in the Intensive Care Unit: if this product is administered for more than 24 hours and is abruptly discontinued, it may result in withdrawal symptoms similar to those reported with another alpha2-adrenergic agent, colistin. These symptoms include nervousness, agitation, and headache, accompanied or followed by a rapid increase in blood pressure and elevated plasma catecholamine concentrations. PROCEDURAL SEDATION: There were no withdrawal symptoms following discontinuation of a short-term infusion of this product ([6 hours). Hepatic Impairment Because the clearance of dexmedetomidine decreases with the severity of hepatic impairment, dose reduction should be considered in patients with hepatic impairment. Dependence The potential dependence of dexmedetomidine in humans has not been studied. However, because studies in rodents and primates have demonstrated that dexmedetomidine has similar pharmacologic effects to colistin, abrupt discontinuation of this product may produce colistin-like withdrawal symptoms.