From the Guidelines
Hypotension can be treated with medications such as epinephrine, norepinephrine, phenylephrine, dopamine, and dobutamine.
Medication Options
- Epinephrine: typically started at a dose of 0.1–0.5 mcg/kg/min (in a 70-kg adult, 7–35 mcg/min) and used to treat severe hypotension (eg, systolic blood pressure 70 mm Hg) 1.
- Norepinephrine: typically started at a dose of 0.1–0.5 mcg/kg/min (in a 70-kg adult, 7–35 mcg/min) and used to treat severe hypotension (eg, systolic blood pressure 70 mm Hg) and a low total peripheral resistance, but relatively contraindicated in patients with hypovolemia 1.
- Phenylephrine: typically started at a dose of 0.5–2.0 mcg/kg/min (in a 70-kg adult, 35–140 mcg/min) and used to treat severe hypotension (eg, systolic blood pressure 70 mm Hg) and a low total peripheral resistance 1.
- Dopamine: typically started at a dose of 5–10 mcg/kg/min and used to treat hypotension, especially if it is associated with symptomatic bradycardia 1.
- Dobutamine: typically started at a dose of 5–10 mcg/kg/min, but its use in hypotension is limited due to its vasodilating effects, which can counterbalance its vasoconstricting effects 1.
Important Considerations
It is essential to note that the choice of medication and dosage may vary depending on the underlying cause of hypotension, patient's medical history, and clinical presentation. Additionally, these medications should be used with caution and under close monitoring, as they can have significant side effects and interactions.
From the Research
Medications for Hypotension
The following medications can be used to treat hypotension:
- Midodrine: an alpha-adrenoceptor agonist that has been shown to increase standing blood pressure and decrease orthostatic symptoms 2
- Droxidopa: a medication that has been found to increase blood pressure and alleviate symptoms of orthostatic hypotension 3
- Fludrocortisone: a mineralocorticoid that increases blood volume and blood pressure, considered first- or second-line pharmacological therapy for orthostatic hypotension 4, 3, 2, 5
- Pyridostigmine: a medication that can be used in patients who fail to respond to midodrine or droxidopa 3, 2
- Atomoxetine: a medication with emerging evidence for its use in treating orthostatic hypotension, particularly in patients with central autonomic failure 3
- Octreotide: a medication that has been shown to elevate standing blood pressure and/or orthostatic tolerance in patients with orthostatic hypotension due to autonomic failure 2
- Beta-blockers: such as atenolol, can decrease recurrence of syncope in patients with orthostatic hypotension associated with neurocardiogenic syncope 2
- Sympathomimetic agents: can be used to treat orthostatic hypotension, but data surrounding their use is minimal 3
- Desmopressin: a medication that can be used to treat symptomatic postprandial hypotension 5
- Indomethacin: a medication that has been shown to elevate standing blood pressure and/or orthostatic tolerance in patients with orthostatic hypotension due to autonomic failure 2
- Ergotamine: a medication that has been shown to elevate standing blood pressure and/or orthostatic tolerance in patients with orthostatic hypotension due to autonomic failure 2
Considerations for Treatment
Treatment of hypotension should be guided by patient-specific factors, such as tolerability, adverse effects, and drug-drug and drug-disease interactions 3, 2. Non-pharmacological measures, such as increasing fluid and salt intake, venous compression methods, and avoiding large carbohydrate-rich meals, should be tried first 4, 3, 6. Medication management should be individualized and based on the underlying cause of the hypotension 3, 2.