What are examples of vasopressors used to treat hypotension?

From the Guidelines

Vasopressors commonly used to treat hypotension include norepinephrine, epinephrine, dopamine, vasopressin, and phenylephrine, with norepinephrine being the first-line agent due to its potent alpha-adrenergic effects and ability to maintain cardiac output 1.

Key Points

• Norepinephrine is typically started at 0.01-0.3 mcg/kg/min and is the recommended first-choice vasopressor for most forms of shock, including septic shock 1.
• Epinephrine (0.01-0.5 mcg/kg/min) offers both alpha and beta effects, making it useful for anaphylactic shock or when additional cardiac support is needed, but its use is generally recommended as an addition to norepinephrine rather than a first-line agent 1.
• Dopamine (1-20 mcg/kg/min) has dose-dependent effects and is suggested for use as an alternative vasopressor agent to norepinephrine only in highly selected patients, such as those with low risk of tachyarrhythmias and absolute or relative bradycardia 1.
• Vasopressin (0.01-0.04 units/min) works through V1 receptors and is often added as a second agent, particularly in septic shock, to either raise mean arterial pressure or decrease norepinephrine dosage 1.
• Phenylephrine (0.1-5 mcg/kg/min) is a pure alpha-agonist that increases blood pressure through vasoconstriction without chronotropic effects, making it useful in situations where tachycardia should be avoided, although its use is not generally recommended as a first-line agent for septic shock 1.

Monitoring and Titration

• These medications require continuous monitoring of blood pressure, heart rate, and perfusion markers, with titration to achieve a mean arterial pressure of at least 65 mmHg while minimizing side effects like excessive vasoconstriction, arrhythmias, or tissue ischemia 1.
• The use of arterial catheters for monitoring is suggested for all patients requiring vasopressors, as soon as practical if resources are available, to facilitate precise blood pressure management 1.

From the FDA Drug Label

1 INDICATIONS & USAGE Vasopressin injection is indicated to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines.

INDICATIONS & USAGE For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions). As an adjunct in the treatment of cardiac arrest and profound hypotension.

Examples of vasopressors used to treat hypotension include:

• Vasopressin (IV) 2
• Norepinephrine (IV) 3

From the Research

Vasopressors Used to Treat Hypotension

• The following are examples of vasopressors used to treat hypotension:
  • Norepinephrine 4, 5, 6, 7
  • Phenylephrine 4, 5, 6, 8, 7
  • Dopamine 5, 6, 7
  • Epinephrine 5, 6, 8, 7
  • Vasopressin 5, 6, 8, 7

Clinical Applications of Vasopressors

• Vasopressors are used in various clinical scenarios, including:
  • Septic shock 4, 5, 6, 7
  • Vasoplegic shock after cardiac surgery 4
  • Trauma-induced hypotension 4
  • Hypovolemic shock 6
  • Cardiogenic shock 6, 7
  • Obstructive shock 6

Administration of Vasopressors

• Vasopressors can be administered through:
  • Continuous infusions through central venous access 6
  • Peripheral administration 6
  • Push-dose administration 6, 8