Vasopressors Used in Shock Statesa
| Drug | Dose | Notes |
|---|---|---|
| Dopamine | 1-2 µg/kg per min | Facilitates diuresis |
| 2-10 µg/kg per min | Positive inotropic and chronotropic effects; may increase O2 consumption as well as O2 delivery; use may be limited by tachycardia | |
| 10-20 µg/kg per min | Generalized vasoconstriction (decrease renal perfusion) | |
| Norepinephrine | 0.5-30 µg/min | Potent vasoconstrictor; moderate inotropic effect; in septic shock is thought to increase tissue O2 consumption as well as O2 delivery; may be chosen over dopamine in sepsis due to less chronotropic and adverse effects; may be useful in cardiogenic shock with reduced SVR but should generally be reserved for refractory hypotension |
| Dobutamine | 2-20 µg/kg per min | Primarily for cardiogenic shock (Chap. 119. ST-Segment Elevation Myocardial Infarction): positive inotrope; lacks vasoconstrictor activity; most useful when only mild hypotension present and avoidance of tachycardia desired |
| Phenylephrine | 40-180 µg/min | Potent vasoconstrictor without inotropic effect; may be useful in distributive (septic) shock |
| Vasopressin | 0.01-0.04 U/min | Occasionally used in refractory septic (distributive) shock; restores vascular tone in vasopressin-deficient states (e.g., sepsis) |
aIsoproterenol not recommended in shock states because of potential hypotension and arrhythmogenic effects.
Abbreviation: SVR, systemic vascular resistance.