Table 2.

Summary of Systemic Vasopressors

Agents	Mechanism	Effect	Indications	Considerations
Phenylephrine	A1 agonist	Vasoconstriction	Various forms of shock	Caution in cardiac dysfunction as it increases afterload
Norepinephrine	A<B agonist	Inotropy, chronotropy, dromotropy, and vasoconstriction	Most common first line agent in shock	Most benefits demonstrated in septic shock
Epinephrine	A≪B agonist	Inotropy, chronotropy, dromotropy, and vasoconstriction	Commonly used as second line agent or first line in anaphylactic shock	Surviving Sepsis Guidelines has most data for epinephrine as second line agent
Dopamine	Dose dependent A, B, and D agonism	Inotropy, dromotropy, chronotropy, and vasoconstriction (at highest doses)	Second line agent in most forms of shock	SOAP II trial demonstrated more incidence of tachy‐arrythmias and increased mortality in CS patients when dopamine was used as first line
Vasopressin	V1 agonist	Vasoconstriction	Second line agent in most forms of shock	On or Off dosing, can cause hyponatremia
Dobutamine	B agonist	Inotropy and mild vasodilation	Commonly used in cardiogenic shock	May contribute to hypotension
Levosimendan	Myofilament Ca2+ sensitizer and K+ channel modifier	Ionotropy and inodilator	Used in acutely decompensated chronic heart failure	Minimal effect on myocardial oxygen consumption

CS indicates cardiogenic shock; SOAP, Sepsis Occurrence in Acutely Ill Patients.