Vasopressors used to treat vasoplegic syndrome

Drug	Dose	Description
Norepinephrine	1 to 20 mcg/minute or 0.01 to 0.3 mcg/kg/minute	Alpha₁- and beta₁-adrenergic receptor agonist; adrenergic-mediated vascular smooth muscle vasoconstriction and beta-receptor-mediated release of AT-II in kidneys
Vasopressin	0.01 to 0.04 units/minute	Vasopressin₁ and vasopressin₂ receptor agonist; direct vascular smooth muscle vasoconstriction and increased permeability of collecting ducts to water
Phenylephrine	10 to 100 mcg/minute or 0.1 to 1 mcg/kg/minute	Alpha₁-selective adrenergic receptor agonist; adrenergic-mediated vascular smooth muscle vasoconstriction
Methylene blue	1 to 2 mg/kg IV over 10 to 20 minutes, followed by 0.5 to 1 mg/kg/hour infusion	Inhibits NOS and GC activation to inhibit vascular smooth muscle relaxation
Angiotensin II	Start at 10 to 20 ng/kg/minute, then titrate every 5 minutes by up to 15 ng/kg/minute increments to a maximum dose of 80 ng/kg/minute for the first 3 hours. The maximum maintenance dose should not exceed 40 ng/kg/minute.	Octapeptide that causes venous and arterial smooth muscle vasoconstriction and acts on the CNS to increase vasopressin production
Hydroxocobalamin	5 g IV over 5 to 10 minutes	Vitamin B₁₂ form that causes direct binding of NO and inhibitory effects on NOS and GC to inhibit vascular smooth muscle relaxation

AT-II: angiotensin II; IV: intravenous; NOS: nitric oxide synthase; GC: guanylyl cyclase; CNS: central nervous system; NO: nitric oxide.

Graphic 126194 Version 3.0