Chart — Critical Care
Vasopressor Comparison Chart
Side-by-side comparison of six vasoactive agents used in critical care — receptor profiles, hemodynamic effects, typical dose ranges, primary indications, and clinical cautions to support learning about vasopressor selection.
Data Source: Surviving Sepsis Campaign / ACLS Guidelines
Educational use only. Vasoactive agent selection, dosing, and titration are provider decisions that require provider orders, pharmacy verification, and continuous hemodynamic monitoring. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Receptor Key
Vasopressor and Vasoactive Agent Comparison
| Drug (Brand) | Type | Receptors | CO | SVR | HR | Typical Dose | Primary Indication |
|---|---|---|---|---|---|---|---|
| NorepinephrineLevophed | Vasopressor | α1 >> β1 | ↔ / mild ↑ | ↑↑ | ↔ / mild ↑ | 0.01–3 mcg/kg/min | Septic shock (first-line); distributive shock |
| EpinephrineAdrenalin | Vasopressor + Inotrope | α1 + β1 + β2 | ↑↑ | ↑ | ↑↑ | 0.01–1+ mcg/kg/min; 1 mg q3–5min (arrest) | Anaphylaxis; cardiac arrest; refractory septic shock |
| DopamineIntropin | Vasopressor + Inotrope | DA → β1 → α1 (dose-dependent) | ↑ (mid dose) | ↑ (high dose) | ↑ | 2–20 mcg/kg/min | Cardiogenic shock with bradycardia (second-line); bradycardia (ACLS) |
| DobutamineDobutrex | Inotrope | β1 >> β2; minimal α | ↑↑ | ↓ (mild) | ↑ | 2–20 mcg/kg/min | Cardiogenic shock; low CO with high SVR — inotrope, NOT a vasopressor |
| VasopressinPitressin / ADH | Vasopressor | V1 (non-adrenergic) | ↔ | ↑ | ↓ (reflex) | 0.03–0.04 units/min fixed | Adjunct in refractory septic shock; catecholamine sparing |
| PhenylephrineNeo-Synephrine | Vasopressor | α1 only | ↔ / ↓ | ↑↑ | ↓ (reflex bradycardia) | 0.4–9.1 mcg/kg/min | Hypotension with tachycardia; neurogenic shock; spinal/intraoperative hypotension |
CO = Cardiac Output | SVR = Systemic Vascular Resistance | HR = Heart Rate | ↑↑ = significantly elevated | ↑ = elevated | ↔ = unchanged | ↓ = decreased
Clinical Cautions by Drug
| Drug | Key Cautions and Nursing Notes |
|---|---|
| Norepinephrine | Peripheral ischemia with prolonged high doses; requires central access |
| Epinephrine | Elevates lactate directly; tachyarrhythmias; hyperglycemia |
| Dopamine | Higher dysrhythmia rate vs norepinephrine; dose-response varies by patient |
| Dobutamine | May drop BP from vasodilation; tachycardia; not for use without adequate preload |
| Vasopressin | Fixed rate only — not titrated; ischemia risk in high doses; hyponatremia |
| Phenylephrine | Reflex bradycardia; reduces CO — avoid in cardiogenic shock; pure vasoconstrictor |
First-Line Agent by Shock State
| Shock State | First-Line Agent | Rationale |
|---|---|---|
| Septic | Norepinephrine | ↓SVR — needs vasoconstriction; first-line per Surviving Sepsis Campaign. Add vasopressin if MAP goal not achieved. |
| Anaphylactic | Epinephrine IM | All three receptor types needed: α1 (BP), β1 (HR/CO), β2 (bronchodilation) |
| Cardiogenic | Dobutamine | ↓CO — needs inotropic support, not just vasoconstriction; norepinephrine for MAP support |
| Neurogenic | Phenylephrine or Norepinephrine | ↓SVR without tachycardia (phenylephrine if HR normal); norepinephrine if bradycardia present |
| Hypovolemic | Fluid resuscitation first | Volume depletion — fill the tank before squeezing vessels |
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Surviving Sepsis Campaign / ACLS Guidelines. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →