Vasopressors are potent pharmacologic agents that are used to increase blood pressure and mean arterial pressure by vasoconstriction, thus increasing systemic vascular resistance. As such, they should be reserved for cases of persistent hypotension and tissue hypoperfusion after volume resuscitation has failed. Most vasopressors have multiple actions on the heart and vasculature and have a propensity to cause arrhythmias. Some vasopressors are also inotropes and are used to improve cardiac output, particularly in patients with left ventricular pump failure or cardiogenic shock. Table 20-11,2,3 provides a summary of common vasopressor and inotropic agent doses, effects, and uses.
TABLE 20-1Summary of Common Vasopressor Doses, Effects, and Uses |Favorite Table|Download (.pdf) TABLE 20-1 Summary of Common Vasopressor Doses, Effects, and Uses
|Drug ||Dose Range ||Receptor Activation ||Cardiovascular Effects ||Use |
|Dopamine ||2–20 micrograms/kg/min || |
<5 micrograms/kg/min: DA1, DA2
5–10 micrograms/kg/min: β1
>10 micrograms/kg/min: α1
|*↑HR, BP, CO, SVR ||Cardiogenic shock, vasodilatory shock |
|Epinephrine ||2–10 micrograms/min or 0.05–0.5 micrograms/kg/min ||α1, β1, β2 ||↑HR, BP, MAP, SV, SVR, CO ||Cardiogenic shock, vasodilatory shock, ACLS |
|Norepinephrine ||2–50 micrograms/min or 0.02–2 micrograms/kg/min ||α1, β1 ||↑BP, MAP, SVR, CO ||Cardiogenic shock, vasodilatory shock |
|Phenylephrine ||50–300 micrograms/min or 0.02–2 micrograms/kg/min ||α1 ||↑BP, MAP, SVR ||Vasodilatory shock, obstructive shock |
|Vasopressin ||0.01–0.04 units/min ||V1 ||↑BP, SVR ||Cardiogenic shock, vasodilatory shock, ACLS |
|Dobutamine ||2–20 micrograms/kg/min ||β1, β2 ||↑HR, BP, MAP, CO; ↓SVR ||ADHF, cardiogenic shock, vasodilatory shock |
|Milrinone ||50 micrograms/kg bolus (optional); 0.25–0.75 micrograms/kg/min† ||N/A ||↑HR, BP, MAP, CO; ↓SVR ||ADHF |
Dopamine is an endogenous catecholamine and a metabolic precursor of norepinephrine and epinephrine that acts on dopaminergic, α1, β1, and β2 receptors in a dose-dependent fashion. At intermediate doses (5 to 15 micrograms/kg/min), dopamine increases renal blood flow, heart rate, cardiac contractility, and cardiac output. At high doses (>15 micrograms/kg/min), the α-adrenergic effects of dopamine dominate, leading to vasoconstriction and increased blood pressure. Low-dose (renal dose) dopamine is no longer recommended for renal protection due to lack of data support.4
TABLE 20-2Dopamine Pharmacokinetics (IV) |Favorite Table|Download (.pdf) TABLE 20-2 Dopamine Pharmacokinetics (IV)
|Metabolism ||Excretion ||Half-Life ||Onset/Duration of Action |
|Renal, hepatic, plasma; 75% to inactive metabolites by monoamine oxidase and 25% to norepinephrine ||Urine (as metabolites) ||~2 min...|
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