Template:Vasopressor table: Difference between revisions
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! Pressor!! Initial Dose !! Max Dose !! Cardiac Effect  !! BP Effect !! [[Arrhythmias]] !! Special Notes
! Pressor!! Initial Dose !! Max Dose !! Cardiac Effect  !! BP Effect !! [[Arrhythmias]] !! Special Notes
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| [[Dobutamine]] || 2.5mcg/kg/min || 10-40 mcg/kg/min || mainly inotrope (ß1) || alpha effect minimal || Some HR(ß1) increase. Also Increase SA and AV node fx || Debut Research 1979<ref>Edmund H. Sonnenblick, M.D., William H. Frishman, M.D., and Thierry H. LeJemtel, M.D. Dobutamine: A New Synthetic Cardioactive Sympathetic Amine</ref> Isoproterenol has most Β2 vasodilatory and Β1 HR effects
| [[Dobutamine]] || 2.5 mcg/kg/min || 10-40 mcg/kg/min || mainly inotrope (ß1) || alpha effect minimal || Some HR(ß1) increase. Also Increase SA and AV node fx || Debut Research 1979<ref>Edmund H. Sonnenblick, M.D., William H. Frishman, M.D., and Thierry H. LeJemtel, M.D. Dobutamine: A New Synthetic Cardioactive Sympathetic Amine</ref> Isoproterenol has most Β2 vasodilatory and Β1 HR effects
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| [[Dopamine]] || 2mcg/kg/min || 20-50 mcg/kg/min || β1 and NorEpi release || α effects if > 20mcg/kg/min || Arrhythmogenic from β1 effects || More adverse events when used in shock compared to Norepi<ref name="soap2">De Backer Daniel et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM 363(9). 779-789</ref>
| [[Dopamine]] || 2 mcg/kg/min || 20-50 mcg/kg/min || β1 and NorEpi release || α effects if > 20mcg/kg/min || Arrhythmogenic from β1 effects || More adverse events when used in shock compared to Norepi<ref name="soap2">De Backer Daniel et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM 363(9). 779-789</ref>
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| [[Epinepherine]] ||0.1-1 mcg/kg/min||  ||  ||  ||  ||  
| [[Epinepherine]] ||0.1-1 mcg/kg/min||  ||  ||  ||  ||  
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| [[Norepinephrine]] || 8-12mcg/min || 30 mcg/min || β1 direct effect || β1 and α1,2 effects || Less arrhythmias than Dopamine<ref  name="soap2"></ref>  || Increases MAP, coronary perfusion pressure, little β2 effects.
| [[Norepinephrine]] || 8-12 mcg/min || 30 mcg/min || β1 direct effect || β1 and α1,2 effects || Less arrhythmias than Dopamine<ref  name="soap2"></ref>  || Increases MAP, coronary perfusion pressure, little β2 effects.
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|[[Milrinone]] || 50mcg/kg x 10 min || 0.375-75mcg/kg/min || Direct influx of Ca<sup>2+</sup> channels|| Smooth muscle vasodilator ||  || PDE Inhibitor which increases Ca<sup>2+</sup> uptake by sarcolemma.  No venodilatory activity  
|[[Milrinone]] || 50 mcg/kg x 10 min || 0.375-75 mcg/kg/min || Direct influx of Ca<sup>2+</sup> channels|| Smooth muscle vasodilator ||  || PDE Inhibitor which increases Ca<sup>2+</sup> uptake by sarcolemma.  No venodilatory activity  
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| [[Phenylephrine]] || 100-180mcg/min then 40-60mcg/min || 0.4-9 mcg/kg/min  ||  || Alpha agonist  ||  || Long half life
| [[Phenylephrine]] || 100-180 mcg/min then 40-60 mcg/min || 0.4-9 mcg/kg/min  ||  || Alpha agonist  ||  || Long half life
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| [[Vasopressin]] || Fixed Dose || 0.4 U/min || unknown || increases via ADH peptide ||  || should not be titrated due to ischemic effects  
| [[Vasopressin]] || Fixed Dose || 0.4 U/min || unknown || increases via ADH peptide ||  || should not be titrated due to ischemic effects  
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| [[Methylene blue]]<ref>Pasin L et al. Methylene blue as a vasopressor: a meta-analysis of randomised trials. Crit Care Resusc. 2013 Mar;15(1):42-8.</ref>|| IV bolus 2 mg/kg over 15 min || 1-2 mg/kg/hour || Possible increased inotropy, cardiac use of ATP || Inhibits NO mediated peripheral vasodilation ||  || Don't use in [[G6PD deficiency]], [[ARDS]], [[pulmonary hypertension]]
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{{Vasopressor critical care table}}
{{Vasopressor critical care table}}

Revision as of 23:46, 26 February 2017

Vasopressors

Pressor Initial Dose Max Dose Cardiac Effect BP Effect Arrhythmias Special Notes
Dobutamine 2.5 mcg/kg/min 10-40 mcg/kg/min mainly inotrope (ß1) alpha effect minimal Some HR(ß1) increase. Also Increase SA and AV node fx Debut Research 1979[1] Isoproterenol has most Β2 vasodilatory and Β1 HR effects
Dopamine 2 mcg/kg/min 20-50 mcg/kg/min β1 and NorEpi release α effects if > 20mcg/kg/min Arrhythmogenic from β1 effects More adverse events when used in shock compared to Norepi[2]
Epinepherine 0.1-1 mcg/kg/min
Norepinephrine 8-12 mcg/min 30 mcg/min β1 direct effect β1 and α1,2 effects Less arrhythmias than Dopamine[2] Increases MAP, coronary perfusion pressure, little β2 effects.
Milrinone 50 mcg/kg x 10 min 0.375-75 mcg/kg/min Direct influx of Ca2+ channels Smooth muscle vasodilator PDE Inhibitor which increases Ca2+ uptake by sarcolemma. No venodilatory activity
Phenylephrine 100-180 mcg/min then 40-60 mcg/min 0.4-9 mcg/kg/min Alpha agonist Long half life
Vasopressin Fixed Dose 0.4 U/min unknown increases via ADH peptide should not be titrated due to ischemic effects
Methylene blue[3] IV bolus 2 mg/kg over 15 min 1-2 mg/kg/hour Possible increased inotropy, cardiac use of ATP Inhibits NO mediated peripheral vasodilation Don't use in G6PD deficiency, ARDS, pulmonary hypertension
Medication IV Dose (mcg/kg/min) Concentration
Norepinephrine (Levophed) 0.1-2 mcg/kg/min 8mg in 500mL D5W
Dopamine 2-20 mcg/kg/min 400mg in 250 D5W
Dobutamine 2-20 mcg/kg/min 250mg in 250 mg D5W
Epinephrine 0.1-1 mcg/kg/min 1mg in 250 D5W
  1. ↑ Edmund H. Sonnenblick, M.D., William H. Frishman, M.D., and Thierry H. LeJemtel, M.D. Dobutamine: A New Synthetic Cardioactive Sympathetic Amine
  2. ↑ 2.0 2.1 De Backer Daniel et al. Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM 363(9). 779-789
  3. ↑ Pasin L et al. Methylene blue as a vasopressor: a meta-analysis of randomised trials. Crit Care Resusc. 2013 Mar;15(1):42-8.
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