Common Vasoactive Drugs

Drug Typical Starting Dose (Then Titrate to Effect)
Epinephrine 0.1–0.5 mcg/kg/min (In 70-kg adult, 7–35 mcg/min)

  • Useful for symptomatic bradycardia if atropine and transcutaneous pacing fail or if pacing is not available

  • Used to treat severe hypotension (eg, systolic blood pressure <70 mm Hg)

  • Useful for anaphylaxis associated with hemodynamic instability or respiratory distress1

Norepinephrine 0.1–0.5 mcg/kg/min (In 70-kg adult, 7–35 mcg/min)

  • Used to treat severe hypotension (eg, systolic blood pressure <70 mm Hg) and a low total peripheral resistance

  • Relatively contraindicated in patients with hypovolemia. It may increase myocardial oxygen requirements, mandating cautious
    use in patients with ischemic heart disease

  • Usually induces renal and mesenteric vasoconstriction; in sepsis, however, norepinephrine improves renal blood flow and urine
    output2,3

Phenylephrine 0.5–2.0 mcg/kg/min (In 70-kg adult, 35–140 mcg/min)

  • Used to treat severe hypotension (eg, systolic blood pressure <70 mm Hg) and a low total peripheral resistance

Dopamine 5–10 mcg/kg/min

  • Used to treat hypotension, especially if it is associated with symptomatic bradycardia

  • Although low-dose dopamine infusion has frequently been recommended to maintain renal blood flow or improve renal function,
    more recent data have failed to show a beneficial effect from such therapy4,5

Dobutamine 5–10 mcg/kg/min

  • The (+) isomer is a potent beta-adrenergic agonist, whereas the (–) isomer is a potent alpha-1-agonist6

  • The vasodilating beta2-adrenergic effects of the (+) isomer counterbalance the vasoconstricting alpha-adrenergic effects, often leading to little
    change or a reduction in systemic vascular resistance

Milrinone Load 50 mcg/kg over 10 minutes then infuse at 0.375 mcg/kg/min

  • Used to treat low cardiac output

  • May cause less tachycardia than dobutamine

References

  1. Vasquez A, Kern KB, Hilwig RW, Heidenreich J, Berg RA, Ewy GA. Optimal dosing of dobutamine for treating post-resuscitation left ventricular dysfunction. Resuscitation. 2004;61:199–207.
  2. Gisvold SE, Sterz F, Abramson NS, Bar-Joseph G, Ebmeyer U, Gervais H, Ginsberg M, Katz LM, Kochanek PM, Kuboyama K, Miller B, Obrist W, Roine RO, Safar P, Sim KM, Vandevelde K, White RJ, Xiao F. Cerebral resuscitation from cardiac arrest: treatment potentials. Crit Care Med. 1996;24(2 Suppl):S69–80.
  3. del Zoppo GJ, Mabuchi T. Cerebral microvessel responses to focal ischemia. J Cereb Blood Flow Metab. 2003;23:879–894.
  4. Zandbergen EG, de Haan RJ, Stoutenbeek CP, Koelman JH, Hijdra A. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet. 1998;352():1808–1812.
  5. Rothstein TL. Recovery from near death following cerebral anoxia: A case report demonstrating superiority of median somatosensory evoked potentials over EEG in predicting a favorable outcome after cardiopulmonary resuscitation. Resuscitation. 2004;60:335–341.
  6. Kaplan PW, Genoud D, Ho TW, Jallon P. Etiology, neurologic correlations, and prognosis in alpha coma. Clin Neurophysiol. 1999;110:205–213.