Learn more about Elsevier's Drug Information today! Get the drug data and decision support you need, including TRUE Daily Updates™ including every day including weekends and holidays.
Adrenergic vasopressors activate 3 types of receptors: 1) alpha-adrenergic, 2) beta-adrenergic, and 3) dopaminergic. Dopamine is the metabolic precursor of norepinephrine and displays dose-related receptor activity. At infusion rates of less than 5 mcg/kg/minute, dopamine targets dopaminergic receptors. At infusion rates of 5 to 10 mcg/kg/minute, it continues to stimulate dopaminergic receptors but also activates beta-receptors. At high doses, dopamine maintains beta activity while preferentially targeting alpha-receptors. Norepinephrine, the precursor of epinephrine, is much more selective in its targeting of alpha- and beta-receptors than dopamine and has no activity at dopaminergic receptors. Epinephrine is a potent nonselective alpha- and beta-agonist. Its beta effects predominate at lower doses, while alpha1-mediated vasoconstriction predominates at high doses. Phenylephrine is a pure alpha1-agonist, which increases blood pressure via peripheral vasoconstriction.
Non-adrenergic vasopressors include vasopressin and angiotensin II. Vasopressin causes potent peripheral vasoconstriction via vasopressin receptors located on vascular smooth muscle cells. Angiotensin II causes vasoconstriction and increases the release of aldosterone.
Receptor Pharmacology of Vasopressors 
0.5 to 5
5 to 10
10 to 20
0.01 to 0.1
0.1 to 0.2
*Dose listed for dose-related receptor activity only
Locations and Responses of Select Receptors
vascular smooth muscle
positive inotropy and chronotropy
vascular and bronchial smooth muscle
renovascular smooth muscle
Vasoconstrictors can increase myocardial oxygen consumption by increasing ventricular wall tension and decrease myocardial oxygen supply via vasoconstriction of coronary vessels; this can induce myocardial ischemia. Catecholamines can trigger tachyarrhythmias; tachycardia and arrhythmogenesis are more prominent with dopamine than with other vasopressor agents.
Splanchnic hypoperfusion and extensive peripheral vasoconstriction may occur with potent vasoconstrictors.
Catecholamines may have potentially harmful effects on pituitary hormone secretion and immune function; these effects appear to be greatest with dopamine and least with norepinephrine.    
Epinephrine can increase blood glucose and lactate concentrations via stimulation of beta-receptors.
In general, antihypertensives decrease the response to vasopressors.   Due to their mechanism, angiotensin-converting enzyme (ACE) inhibitors may increase the response to angiotensin II while angiotensin II receptor blockers may decrease the response to angiotensin II. The cardiac effects of dopamine are antagonized by beta-blockers. However, beta-blockers may potentiate the pressor and arrhythmogenic effects of epinephrine. 
Vasodilators (e.g., nitrates, phosphodiesterase inhibitors) antagonize the effects of vasopressors.
Digoxin may potentiate the arrhythmogenic effects of catecholamines.
Halogenated anesthetics increase cardiac autonomic irritability and may sensitize the myocardium to the action of intravenous catecholamines resulting in ventricular arrhythmias.  
Use sympathomimetic vasopressors with caution in patients taking monoamine oxidase inhibitors (MAOIs), including linezolid, due to the risk of severe, prolonged hypertension; reduce the initial vasopressor dose and carefully titrate. In general, do not use sympathomimetic agents concurrently or within 14 days of an MAOI due to an increased risk of hypertensive crisis.      
Use sympathomimetic vasopressors with caution in patients taking tricyclic antidepressants due to the risk of severe, prolonged hypertension.   
Do not use epinephrine to counteract circulatory collapse or hypotension caused by phenothiazines due to a paradoxical further lowering of blood pressure. If a vasoconstrictor is required, norepinephrine and phenylephrine are most suitable.
Never inject intravascular contrast medium after the administration of vasopressors due to potentiation of severe neurologic effects.
Administer vasopressors through a central vein whenever possible; prolonged administration through a peripheral vein may result in extravasation and skin necrosis. If peripheral administration is necessary, use a 20-gauge or larger catheter and assess the site frequently. If extravasation occurs, administer phentolamine 5 to 10 mg directly to the site. 
Correct hypovolemia by restoring blood volume with a suitable plasma expander or whole blood before vasopressor administration. If a vasopressor is continuously administered to maintain blood pressure in the absence of blood volume replacement, severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite normal blood pressure, tissue hypoxia, and lactic acidosis may occur.  
Patients with a pheochromocytoma may experience a greater sensitivity to the adverse effects of catecholamines. 
Nardil (phenelzine) tablet package insert. New York, NY: Pfizer; 2009 Feb.
Lanoxin (digoxin) tablets package insert. St. Michael, Barbados: Concordia Pharmaceuticals Inc.; 2020 Apr..
Zyvox (linezolid) package insert. New York, NY: Pharmacia and Upjohn Company; 2021 Oct.
Thorazine (chlorpromazine) package insert. Research Triangle Park, NC: GlaxoSmithKline; 2017 Mar.
Dopamine hydrochloride and 5% dextrose injection package insert. Deerfield, IL: Baxter Healthcare Corporation; 2017 Jul.
Levophed (norepinephrine bitartrate) injection package insert. Lake Forest, IL: Hospira, Inc.;2020 Jun.
Hollenberg SM, Ahrens TS, Annane D, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004;32:1928-1948.
De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010;362:779-89.
Overgaard CB, Dzavik V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation 2008;118:1047-1056.
Vazculep (phenylephrine) injection package insert. Chesterfield, Mo: Avadel Legacy Pharmaceuticals, LLC; 2019 Oct.
Epinephrine 1 mg/mL injection package insert. Largo, FL: Belcher Pharmaceuticals, LLC; 2021 Sept.
Conray (iothalamate meglumine) injection package insert. Raleigh, NC: Guerbet; 2022 Feb.
Giapreza (angiotensin II) injection package insert. San Diego, CA: La Jolla Pharmaceutical Company; 2017 Dec.
Khanna A, English SW, Wang XS, et al. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med 2017;377:419-430.
Biorphen (phenylephrine hydrochloride) injection package insert. Deer Park, IL; Eton Pharmaceuticals, Inc.: 2021 Mar.
Bockenstedt TL, Baker SN, Weant KA, et al. Review of vasopressor therapy in the setting of vasodilatory shock. Adv Emerg Nurs J 2012;34:16-23.
Stratton L, Berlin DA, Arbo JE. Vasopressors and inotropes in sepsis. Emerg Med Clin N Am 2017;35:75-91.
Allen JM. Understanding vasoactive medications: focus on pharmacology and effective titration. J Infus Nurs 2014;37:82-86.
Cooper BE. Review and update on inotropes and vasopressors. AACN Adv Crit Care 2008;19:5-13.
Hollenberg SM. Inotrope and vasopressor therapy of septic shock. Crit Care Clin 2009;25:781-802.
Russell JA, Walley KR, Singer J, et al. vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008;358:877-887.
Gordon AC, Mason AJ, Thirunavukkarasu N, et al. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA 2016; 316:509-518.
Myburgh JA, Higgins A, Jovanovska A. A comparison of epinephrine and norepinephrine in critically ill patients. Intensive Care Med 2008;34:2226-2234.
Smith N, Lopez RA, Silberman M. Distributive shock. [Updated 2020 Apr 24]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020 Jan.
Bangash MN, Kong ML, Pearse RM. Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol 2012;165:2015-2033.
Jentzer JC, Coons JC, Link CB, et al. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. J Cardiovasc Pharmacol Ther 2015;20:249-260.
Mukoyama T, Kinoshita K, Nagao K, et al. Reduced effectiveness of vasopressin in repeated doses for patients undergoing prolonged cardiopulmonary resuscitation. Resuscitation 2009;80;755-761.
Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Cardiovascular Life Support: 2020 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142:S366-S468.
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021; doi: 10.1097/CCM.0000000000005337. Epub ahead of print.
Cookies are used by this site. To decline or learn more, visit our cookies page.