Table 1.
Common Vasoactive Medications, Indication for Clinical Use, Adverse Effects, and Receptor Affinity
| Agent | Indication | Side effects | β1 affinity | β2 affinity | α1 affinity |
|---|---|---|---|---|---|
| Catecholamines | |||||
| Epinephrine | CS with hypotension, vasoplegic shock, bradycardia, anaphylaxis | Hypertension, skin necrosis with extravasation, digital ischemia, tachycardia, myocardial ischemia, and arrhythmias | ++++ | +++ | +++ |
| Norepinephrine | CS with hypotension, vasoplegic shock | Hypertension, skin necrosis with extravasation, digital ischemia, arrhythmias | +++ | + | +++++ |
| Dobutamine | CS with preserved blood pressure (decompensated heart failure, low cardiac output state) | Tachycardia, myocardial ischemia, ventricular and atrial arrhythmias | ++++ | +++ | + |
| Metaraminol | Hypotension (vagally mediated), hypotension with severe aortic stenosis or obstructive hypertrophic cardiomyopathy | Reflex bradycardia, hypertension | Nil | Nil | +++++ |
| Phenylephrine | Hypotension (vagally mediated), hypotension with severe aortic stenosis or obstructive hypertrophic cardiomyopathy | Reflex bradycardia, hypertension | Nil | Nil | +++++ |
| Phosphodiesterase inhibitor | |||||
| Milrinone | CS with preserved blood pressure (decompensated heart failure, low cardiac output state), CS receiving chronic beta blocker therapy, and postcardiotomy shock | Hypotension, ventricular arrhythmia, drug accumulation in renal failure, myocardial ischemia | Inhibits phosphodiesterase 3‐mediated hydrolysis of cAMP, resulting in inotropy and vasodilation | ||
| Calcium sensitizer | |||||
| Levosimendan | CS with preserved blood pressure (decompensated heart failure, low cardiac output state) | Hypotension, tachycardia | Enhances calcium‐dependent troponin C binding and vascular smooth muscle potassium channel activation | ||
| Other | |||||
| Vasopressin | Refractory vasoplegic shock | Hypertension, myocardial ischemia (secondary to coronary spasm), skin ischemia, arrhythmias |
V1a receptor‐mediated vascular smooth muscle vasoconstriction V2 receptor‐mediated water retention |
||
| Methylene blue | Refractory vasoplegic shock | Hypertension, serotonin syndrome, hemolytic anemia (in those with glucose‐6‐phosphate dehydrogenase deficiency) | Inhibition of nitric oxide mediated of cGMP production, resulting in increased smooth muscle mediated vasocontriction | ||
+ through +++++, minimal to maximal relative receptor affinity; cAMP indicates cyclic adenosine monophosphate; and CS, cardiogenic shock.