Pooja Roy, M.D., on Precedex-induced fever | CHEST 2026

Precedex (dexmedetomidine), a sedative widely used in intensive care units, can cause noninfectious fever in critically ill adults and children, with reported rates ranging from 0.4% to 6.3%, according to a narrative review published as an abstract at the 2026 CHEST meeting. Because fever that develops during Precedex use is often attributed to infection rather than the drug, the authors wrote, it can trigger extensive diagnostic testing and antimicrobial treatment.

In an interview conducted at the CHEST meeting, Pooja Roy, M.D., of Houston Methodist, one of the review’s authors, discussed the reasons that Precedex-induced fever so often leads to a full workup. The drug is valued for reducing anxiety and providing sedation, particularly as clinicians prepare patients for extubation, she noted. Her team began looking into the association after seeing fever in patients in the cardiovascular ICU.

Roy compared Precedex-induced fever to central fever. Clinicians typically stop the drug, but they also run a sepsis workup that includes blood and urine cultures, sometimes a tracheal aspirate or bronchoalveolar lavage, and replacement of catheters and other invasive lines — adding to testing volume and staff time.

“There is no particular test that can confirm that this fever is related to Precedex versus something else, so clinicians are bound to do all the studies,” Roy said.

Efforts to build a guideline or algorithm for recognizing the problem are still at a very preliminary stage, according to Roy. She sees room for research into a test that could distinguish Precedex-induced fever from other causes,and suggested pharmaceutical companies could help.

As described in abstract Roy and colleagues conducted the narrative review of dexmedetomidine (the abstract uses the generic name) by searching PubMed, Embase, Cochrane and Google Scholar. They ended up with nine studies. Their conclusion is that dexmedetomidine can cause fever in critically ill adults and children at reported rates ranging from 0.4% to 6.3%. Awareness of the side effect could help clinicians avoid unnecessary diagnostic testing, they conclude.