Vasopressors in Hypotension

Author: Todd A. Seigel, MD
Updated: 8/20/2013

Choosing the Right Vasopressor Agent in Hypotension

Table of Vasopressor Effects, Side Effects, and Prototypical Clinical Scenario

Side effects of vasoactive medications are related both to the direct mechanism of action of the agent, as well as the compensatory mechanisms precipitated by them. Concerning side effects of inotropes include dysrhythmias and increased myocardial oxygen demand, whereas vasopressors can cause undesired limitations in blood flow to the gut and kidneys.

Agent Primary Receptor Primary Impact Potential Side Effect Prototypical Clinical Scenario
Phenylephrine α1 Increased SVR Reflexive decreased HR Neurogenic shock
Vasopressin V Increased SVR Decreased splanchnic flow Adjunct for septic shock
Dobutamine β1, β2 Increased inotropy Transient decreases in SVR (β2 agonsim) Cardiogenic shock from late-stage heart failure
Dopamine (low-dose) D, β1 Increased inotropy and heart rate Tachydysrhythmias Cardiogenic shock, particularly if bradycardic
Epinephrine α1, α2, β1, β2 Increased SVR and inotropy Tachydysrhythmias and decreased splanchnic flow Anaphylaxis
Norepinephrine α1, α2, β1>> β2 Increased SVR and inotropy Decreased splanchnic and renal flow Septic shock
Dopamine (high-dose) D, α1, β1>> β2 Increased SVR and inotropy Tachydysrhythmias and decreased splanchnic/renal flow Bradycardic cardiovascular collapse


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