Vasopressors

Pressor Map Properties of Vasopressors

Infusion Dosing

Usual adult starting doses and titration ranges for continuous intravenous infusion. Doses are weight-based unless noted. Titrate to a target mean arterial pressure, not to a fixed dose. All doses below are for adults; pediatric and neonatal vasopressor management requires separate, age-specific guidance.

Medication	Usual Dose Range
Norepinephrine	0.01–3 mcg/kg/min SSC 2021
Epinephrine	0.01–1 mcg/kg/min Jentzer 2021
Dopamine	2–20 mcg/kg/min SOAP II
	β1-predominant: 5–10 mcg/kg/min
	β1 + α: > 10 mcg/kg/min
Phenylephrine	0.5–4 mcg/kg/min Jentzer 2021
Vasopressin	0.03–0.04 units/min (fixed dose, not weight-based) SSC 2021
Dobutamine	2–20 mcg/kg/min Jentzer 2021

Norepinephrine is the recommended first-line vasopressor for most forms of shock SSC 2021. Vasopressin (up to 0.03 units/min) may be added to reduce norepinephrine requirements in septic shock, rather than titrating norepinephrine to very high doses alone SSC 2021. Dopamine is associated with more arrhythmias than norepinephrine and is no longer a first-line agent SOAP II.

Push-Dose Pressors (High-Alert)

Push-dose (bolus) vasopressors are used in emergency and critical-care resuscitation for temporary hemodynamic support while definitive therapy is established. These are high-alert medications. A single-center observational study of 105 push-dose pressor administrations found a 39% adverse hemodynamic event rate and a 19% human-error rate, with overdoses ranging from 2.5-fold to 100-fold the intended dose Cole 2019. Only one dosing error occurred when a pharmacist was present.

This page does not provide bedside compounding or dilution instructions. Preparation of push-dose pressors requires a formally reviewed institutional medication-safety protocol that addresses:

Standardized, pre-prepared concentrations (pharmacy-prepared when possible)
Independent double-check of drug, concentration, and dose before administration
Labeled syringes with drug name, concentration, and beyond-use date
Clear documentation of each dose administered
Continuous hemodynamic monitoring during and after administration

Clinicians who use push-dose pressors should follow their institution’s approved protocol. In the absence of an institutional protocol, the risks described by Cole et al. warrant extreme caution and a formal safety review before implementing bedside preparation.

Never administer a full cardiac-arrest dose of epinephrine (1 mg, 1:1,000) to a patient with a pulse. Push-dose epinephrine for patients with a pulse Cole 2019. requires a diluted concentration (e.g., 10 mcg/mL or 100 mcg/mL) prepared under Weingart 2015 an institutional medication-safety protocol. The undiluted 1 mg/mL (1:1,000) Cole 2019 cardiac-arrest ampule must never be administered to a patient with a pulse Weingart 2015.

Ephedrine (5–25 mg IV bolus, β1 and indirect α effects, duration approximately 1 hour) is an alternative for transient hypotension in settings such as post-induction or neuraxial anesthesia, but it is not a substitute for continuous-infusion vasopressors in shock Weingart 2015.