The Medical Letter on Drugs and Therapeutics
Vasopressors and Inotropes
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The main purpose of vasopressors is to raise arterial blood pressure, while that of inotropes is to increase cardiac contractility. The choice of drugs is dictated by the clinical setting. Controlled trials comparing the efficacy and safety of these drugs are generally lacking.1,2

Dopamine is frequently used first in the treatment of hypotension and shock of varying etiologies, but a randomized trial (SOAP II) comparing it with norepinephrine in patients with shock found no difference in death rates and more adverse effects with dopamine; a subgroup analysis found a higher rate of death in patients with cardiogenic shock treated with dopamine.3

At lower doses (<5 mcg/kg/min), dopamine mainly affects dopamine1 receptors, increasing renal blood flow, natriuresis and diuresis. At intermediate doses, it also acts ... more      

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