side by side comparison
Vasopressor Comparison: Dopamine vs Norepinephrine vs Vasopressin — Receptor Selectivity and First-Line Use
Septic shock is tanking your patient's MAP and the provider orders a vasopressor — but picking the wrong one can worsen tachycardia, trigger dysrhythmias, or simply fail to raise perfusion pressure. Knowing which agent is first-line, which is dose-dependent, and which is the add-on separates a safe response from a dangerous delay.
Comparison
Side-by-side3 compared
Comparevs
Dimension
Dopamine
Norepinephrine
Vasopressin
Class & mechanism
- Dose-dependent: dopaminergic → β1 → α1
- Potent α1 vasoconstriction + some β1
- ★Non-adrenergic V1-receptor vasoconstriction
Indications
- Shock with bradycardia; symptomatic ↓HR
- ★First-line for septic shock
- Adjunct in refractory septic shock; post-arrest
Route & dosing
- IV infusion; titrate by mcg/kg/min to HR & BP
- IV infusion; titrate up/down to MAP
- IV infusion; fixed dose, not titrated
Key assessment
- Central line preferred — extravasation risk
- Central line preferred — extravasation risk
- Central line preferred — extravasation risk
Monitoring
- Continuous BP/ECG; monitor perfusion & urine output
- Continuous BP/ECG; monitor perfusion & urine output
- Continuous BP/ECG; monitor perfusion & urine output
Adverse effects
- ★Dose-dependent effects + tachydysrhythmias
- Reflex bradycardia; peripheral ischemia
- No chronotropy; splanchnic/skin ischemia
Extravasation / antidote
- Extravasation → necrosis; antidote phentolamine
- Extravasation → necrosis; antidote phentolamine
- Extravasation → necrosis; antidote phentolamine
BP target
- Titrate to MAP ≥ 65
- Titrate to MAP ≥ 65
- Titrate to MAP ≥ 65
Family / care teaching
- Continuous ICU monitoring; report IV site pain
- Continuous ICU monitoring; report IV site pain
- Continuous ICU monitoring; report IV site pain
Class & mechanism
Dopamine
- Dose-dependent: dopaminergic → β1 → α1
Norepinephrine
- Potent α1 vasoconstriction + some β1
Indications
Dopamine
- Shock with bradycardia; symptomatic ↓HR
Norepinephrine
- ★First-line for septic shock
Route & dosing
Dopamine
- IV infusion; titrate by mcg/kg/min to HR & BP
Norepinephrine
- IV infusion; titrate up/down to MAP
Key assessment
Dopamine
- Central line preferred — extravasation risk
Norepinephrine
- Central line preferred — extravasation risk
Monitoring
Dopamine
- Continuous BP/ECG; monitor perfusion & urine output
Norepinephrine
- Continuous BP/ECG; monitor perfusion & urine output
Adverse effects
Dopamine
- ★Dose-dependent effects + tachydysrhythmias
Norepinephrine
- Reflex bradycardia; peripheral ischemia
Extravasation / antidote
Dopamine
- Extravasation → necrosis; antidote phentolamine
Norepinephrine
- Extravasation → necrosis; antidote phentolamine
BP target
Dopamine
- Titrate to MAP ≥ 65
Norepinephrine
- Titrate to MAP ≥ 65
Family / care teaching
Dopamine
- Continuous ICU monitoring; report IV site pain
Norepinephrine
- Continuous ICU monitoring; report IV site pain
★ marks the fact that sets a column apart.
Clinical Pearl
Sepsis → Norepi first; Dopamine → dose-dependent triple threat; Vasopressin → fixed-dose add-on, never solo.
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