Vasopressor dose equivalence: A scoping review and suggested formula

Shruti Goradia, Arwa Abu Sardaneh, Sujita W. Narayan, Jonathan Penm, Asad E. Patanwala

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations

Abstract

Purpose: Calculating equipotent doses between vasopressor agents is necessary in clinical practice and research pertaining to the management of shock. This scoping review summarizes conversion ratios between vasopressors and provides a formula to incorporate into study designs. Materials and methods: Medline, Embase and Web of Science databases were searched from inception to 21st October 2020. Additional papers were obtained through bibliography searches of retrieved articles. Two investigators assessed articles for eligibility. Clinical trials comparing the potency of at least two intravenous vasopressors (norepinephrine, epinephrine, dopamine, phenylephrine, vasopressin, metaraminol or angiotensin II), with regard to an outcome of blood pressure, were selected. Results: Of 16,315 articles, 21 were included for synthesis. The range of conversion ratios equivalent to one unit of norepinephrine were: epinephrine (0.7–1.4), dopamine (75.2–144.4), metaraminol (8.3), phenylephrine (1.1–16.3), vasopressin (0.3–0.4) and angiotensin II (0.07–0.13). The following formula may be considered for the calculation of norepinephrine equivalents (NE) (all in mcg/kg/min, except vasopressin in units/min): NE = norepinephrine + epinephrine + phenylephrine/10 + dopamine/100 + metaraminol/8 + vasopressin*2.5 + angiotensin II*10. Conclusion: A summary of equipotent ratios for common vasopressors used in clinical practice has been provided. Our formula may be considered to calculate NE for studies in the intensive care unit.

Original languageEnglish (US)
Pages (from-to)233-240
Number of pages8
JournalJournal of Critical Care
Volume61
DOIs
StatePublished - Feb 2021

Keywords

  • Blood pressure
  • Clinical trials
  • Intensive care
  • Scoping review
  • Shock
  • Vasopressor

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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