Shruti Goradia1, Arwa Abu Sardaneh2, Sujita W Narayan3, Jonathan Penm4, Asad E Patanwala5. 1. The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia. Electronic address: sgor2722@uni.sydney.edu.au. 2. The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia. Electronic address: aabu6548@uni.sydney.edu.au. 3. The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia. Electronic address: sujita.narayan@sydney.edu.au. 4. The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia. Electronic address: jonathan.penm@sydney.edu.au. 5. The University of Sydney, Faculty of Medicine and Health, Sydney Pharmacy School, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. Electronic address: asad.patanwala@sydney.edu.au.
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.
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.
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