Commonly Used Vasoactive Inotropic Agents

AgentStandard InfusionIndications
Adrenaline3 mg / 50ml D5W ratio
(6mg in 50ml)
Severe sepsis syndrome / shock
Cardiogenic shock
Acute sever asthma (adjunct)
Anaphylaxis (correct Hypovolaemia!!)
Noradrenaline2 mg / 50 ml D5W ratio
(4 or 8mg in 50ml)
Conditions where mixed α-/ β effect is required with a predominant α-effect ie: septic shock
Dobutamine250 mg / 50 ml D5WPure  β adrenergic agent used in low cardiac output / high vascular resistance states.  Effect may be diminished in sepsis and chronic heart failure due to down regulation of receptors.
10mg/50ml D5W
Cardiogenic shock due to diastolic failure.
Pulmonary hypertension following cardiac valve replacement.
Rescue following catecholamine induced down regulation of receptors in patients requiring ongoing chronoinotrophy.
These agents may accumulate in renal failure.
EphedrineIVI:30 mg / 10ml D5W
Titrated to effect IVI
Oral: 25-50 mg 8 hrly po
Vasopressin20 units / 50 ml D5W at 6 mls/hrCatecholamine  resistant hypotension-limited availability
Levosimendan12.5mg (5ml) in 500ml D5W to run at 0.1mcg/kg/min (17ml/hr for 70kg patient)Give only after discussion with SMO.  No loading dose to be given.
Rocuronium (for rapid sequence induction)1mg/kgAchieves adequate intubating conditions within 60'2.
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Page last reviewed: 13 May 2014