Vasopressor Dosing

Epinephrine:
  • Alpha 1+2, Beta 1+2 receptor agonist
  • Increases  inotropy (contraction) and chronotropy (heart rate)
  • Infusion 0.1-1 mcg/kg/min
Norepinephrine (Levophed):
  • First line agent for septic shock
  • Strong Alpha 1+2 agonist, mild Beta 1 agonist
  • Minimal chronotropic effects (heart rate increase)
  • Infusion 0.1-5 mcg/kg/min
Dopamine:
  • Alpha 1-2 effects at high doses (over 20 mcg/kg/min), Beta 1 effect and NorEpi release.
  • Worsens tachycardia and tachydysrhythmias in shock.
  • Infusion 2-20 mcg/kg/min
Dobutamine:
  • Strong beta 1 effects, weak B2 effects
  • Increases inotroy (contraction) and chronotropy (heart rate), mild vasodilation effects.
  • Infusion 2-20 mcg/kg/min
Milrinone:
  • PDE inhibitor, increases calcium uptake.
  • Improves ventricular contractility and reduces pulmonary hypertension. May lower BP.
  • Infusion 0.375-75 mcg/kg/min
References:
  1. WikEM Vasopressors Link
  2. Döpp-zemel D, Groeneveld AB. High-dose norepinephrine treatment: determinants of mortality and futility in critically ill patients. Am J Crit Care. 2013;22(1):22-32. PubMed
  3. Beale RJ, Hollenberg SM, Vincent JL, Parrillo JE. Vasopressor and inotropic support in septic shock: an evidence-based review. Crit Care Med. 2004;32(11 Suppl):S455-65. PubMed
  4. High Dose Vasopressors – EMCrit
  5. Vasopressor Basics EMCrit

 

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