Which vasopressors are diluted in dextrose (intravenous solution)?

From the Guidelines

Vasopressors commonly diluted in dextrose include dopamine and epinephrine, which are typically prepared in 5% dextrose in water (D5W). The use of dextrose as a diluent helps maintain the stability and efficacy of these catecholamine-based vasopressors, as normal saline contains chloride ions that can promote oxidation of catecholamines, potentially reducing their effectiveness 1. When preparing these vasopressors, standard concentrations are often used:

• dopamine at 0.8-3.2 mg/mL in D5W,
• epinephrine at 4-16 mcg/mL in D5W. Some key points to consider when administering vasopressors include:
• Using an arterial catheter for patients requiring vasopressors as soon as practical if resources are available 1
• Targeting a mean arterial pressure (MAP) of 65 mm Hg with vasopressor therapy 1
• Norepinephrine as the first choice vasopressor, with epinephrine added or substituted when necessary 1 It's essential to note that institutional protocols may vary, and some facilities might use different diluents based on specific patient needs or medication compatibility considerations. Always check your institution's specific guidelines for preparation and administration of these critical medications. In clinical practice, the choice of vasopressor and diluent should prioritize the patient's safety, efficacy, and quality of life, taking into account the most recent and highest-quality evidence available 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Norepinephrine Bitartrate Injection is a concentrated, potent drug which must be diluted in dextrose containing solutions prior to infusion. Diluent: LEVOPHED should be diluted in 5 percent dextrose injection or 5 percent dextrose and sodium chloride injections. 2. 2 Hypotension associated with Septic Shock Dilute 10 mL (1 mg) of epinephrine from the syringe in 1,000 mL of 5 percent dextrose solution or 5 percent dextrose and sodium chloride solution to produce a 1 mcg per mL dilution. Hypotension associated with septic shock: Dilute epinephrine in dextrose solution prior to infusion.

The vasopressors that are diluted in dextrose (intravenous solution) are:

• Norepinephrine: diluted in 5 percent dextrose injection or 5 percent dextrose and sodium chloride injections 2
• Epinephrine: diluted in 5 percent dextrose solution or 5 percent dextrose and sodium chloride solution 3 3

From the Research

Vasopressors Diluted in Dextrose

• Norepinephrine can be diluted in dextrose (5%) in water (D5W) as shown in studies 4, 5
• Dopamine and epinephrine solutions can also be prepared in dextrose-containing solutions, such as 10 gm/dl dextrose in water (D10W) and 5 gm/dl dextrose in water (D5W) 6
• The stability of these vasopressors in dextrose solutions has been evaluated, with results indicating that they remain stable for extended periods 4, 6

Specific Vasopressors and Dextrose Dilution

• Norepinephrine: can be diluted in D5W at concentrations of 4 microg x mL(-1) and 16 microg x mL(-1) 4
• Dopamine: can be prepared in D5W and D10W at various concentrations 6
• Epinephrine: can be prepared in D5W and D10W at various concentrations 6

Clinical Considerations

• The choice of diluent for vasopressors may depend on various factors, including patient-specific needs and institutional policies 5
• The use of dextrose as a diluent for vasopressors may be associated with certain risks, such as hyponatremia and seizure 5
• Clinicians should be aware of the potential risks and benefits of using dextrose as a diluent for vasopressors and follow established guidelines and protocols 5, 7