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.

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Comparison

Side-by-side3 compared
Comparevs
Dimension
Dopamine
Norepinephrine
Vasopressin
Class & mechanism
  • Dose-dependent: dopaminergic then β1 then 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 then necrosis
  • antidote phentolamine
  • Extravasation then necrosis
  • antidote phentolamine
  • Extravasation then 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 then β1 then 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 then necrosis
  • antidote phentolamine

Norepinephrine

  • Extravasation then 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.

Component Topics

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