The document summarizes several vasopressors including dobutamine, dopamine HCL, norepinephrine, epinephrine, vasopressin, and phenylephrine HCL that are used in the treatment of septic shock. It provides information on the mechanism of action, typical dosing, indications for use, contraindications, and common side effects of each vasopressor. The vasopressors are compared in terms of their onset of action, duration of action, and adrenergic receptor effects to guide clinicians in selecting the appropriate vasopressor for different clinical situations.

1. Vels University
School of Pharmaceutical Sciences
Department of Pharmacy Practice and Pharm.D
Vasopressors in treatment of Septic Shock
Onset of Duration of
Drug Mechanism Dose Indications Contraindications Side effects
action action
Strong beta 1 & weak beta 2 2.5 - 10mcg/kg/min IV Inotropic support in Hypersensitivity Tachycardia
effects infraction Idiopathic hypertrophic sub Marked increase in systolic
It produces systemic Cardiac surgery aortic stenosis blood pressure indicate over
Dobutamine 12min 10min
vasodilation and increase Cardiomyopathies dosage
inotropic state Septic shock
Cardiogenic shock
Low dose: mainly stimulates Dopaminergic: Cardiogenic shock in Tachyarrhythmia Nausea
dopaminergic receptors 0.5 - 2mcg/kg/min IV infarction or cardiac surgery Phaeochromocytoma Vomiting
Higher dose: stimulates both Beta: 2 - 10mcg/kg/min IV Peripheral vasoconstriction
Dopamine HCL beta-1 and dopaminergic Alpha: >10mcg/kg/min IV 5min 10min Hypotension
receptors Hypertension
Large dose: stimulate alpha- Tachycardia
adrenergic receptors
Strong alpha & moderate beta- Initial: Usual 8 - 12mcg/min IV Acute hypotension Hypertension Hypertension
1 effects Maintenance: 2 - 4 mcg/min Cardiac arrest Pregnancy Headache
IV Bradycardia
Norepinephrine 1 to 2 min 1 to 2 min
Arrhythmias
Peripheral ischemia
Strong beta-1 & alpha Cardiac arrest 0.5 - 1 mg IV every Ventricular fibrillation Heart disease Anxiety
adrenergic with moderate beta 3 - 5min as needed cardiac arrest Diabetes mellitus Tremor
2 effects May follow initial dose with Cardiopulmonary Hyperthyroidism Tachycardia
Epinephrine 1 - 4 mcg/min IV infusion <1 hour 4 hours
resuscitation Hypertension Headache
(1:10,000 solution) Arrhythmias Cold extremities
Angle closure glaucoma
prompt onset and longer more 0.02-0.1 U/minute IV infusion Pituitary diabetes insipidus Chronic nephritis with Fluid retention
specific antidiuretic action GI hemorrhage (off label) nitrogen retention Pallor
Vasodilatory shock (off label) Tremor
Sweating
Vertigo
Vasopressin 30 to 60 min 2 to 8 hours Headache and nausea
Vomiting
Belching
Abdominal cramps
Constriction of coronary artery
Peripheral ischemia
Strong alpha effects resulting in SC or IM 2 - 5mg, followed Acute hypotension Severe hypertension Headache
increase peripheral vascular 1 - 10mg Priapsim Ventricular tachycardia Reflex bradycardia or
resistance and blood pressure Slow IV 1mg/ml, 100 - 500mcg Closed angle glaucoma tachycardia
Phenylephrine decreases cardiac output and repeated dose if necessary 10 to 15min 15 min Severe hyperthyroidism Arrhythmias
HCL renal perfusion after 15min Pregnancy Peripheral ischemia
IV initial up to 180mcg/min
according to response
Prepared by: J.Mohamed Ali, Pharm.D (PB) 1st year For further information – dicvels@gmail.com