Vasoactive Dose Titration Protocol First Second Primar Notificatio Notification y Typical Dose n Value Value Typical Dose Rate of Dura Route Noteworthy Adverse Drug Starting Titration (notify (notify Range Titration Onset T1/2 Dose Increment provider provider when tion of Effects when dose dose is Elimin is reached) reached) ation 3-6.6 AV block, bradycardia, CHF Diltiazem 1-15 mg/hr 2.5-5 mg/hr 2.5 mg/hr 30-60 min 15 mg/hr 20 mg/hr 3 min 1-3hr hepatic hr exacerbation 2-20 2 2.5 15 20 10 Dobutamine 5-15 min 2 min 2 min hepatic Hypotension, dysrhythmias mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min min 2-20 2-5 1-5 15 20 10 Extravasation causes tissue Dopamine 1-15 min 5 min 2 min renal mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min min necrosis, dysrhythmias 0.01mcg/kg/mi 0.01-0.05 0.01-0.05 0.4 5-10 Dysrhythmias, tissue Epinephrine 1-15 min 2 mcg/kg/min 1-2 min 2 min hepatic n to effect mcg/kg/min mcg/kg/min mcg/kg/min min necrosis, ischemia hydroly 10- zed by 50-300 25-50 50 250 300 Infusion site reactions, Esmolol 5-20 min 1-2 min 30 9 min RBC mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min confusion, bradycardia min esteras es 5-15 2-4 Labetalol 10-180 mg/hr 10 mg/hr 10 mg/hr 10-30 min 120 mg/hr 180 mg/hr 5.5 hr hepatic Hypotension, bradycardia min hr 0.375-0.75 0.375 0.125 0.5 0.75 5-15 1.5-2 Hypotension, dysrhythmias, Milrinone 15-30 min 3-5hr renal mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min min hr nausea, vomiting Peripheral edema, Nicardipine 5-15 mg/hr 2.5-5 mg/hr 2.5 mg/hr 15-30 min 10 mg/hr 15 mg/hr 10 min 2 hr 2-4hr hepatic tachyarrhythmia 10- Hypotension, reflex Nitroglycerin 5-200 5-10 200 5-20 mcg/min 5-15 min 300 mcg/min (mcg/min) mcg/min mcg/min mcg/min 5-10 20 1-3 min hepatic tachycardia if volume min depleted Nitroglycerin 0.2-3 0.2 0.2-0.5 2 5-15 min 3 mcg/kg/min (mcg/kg/min) mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min 0.2-4 0.2 0.25-0.5 4 10 1-2 Hypotension, Nitroprusside 1-15 min 1 min 3-5 min hepatic mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min mcg/kg/min hr cyanide/thiocyanate toxicity 15- 0.01mcg/kg/mi 0.01-0.05 0.01-0.05 0.4 Dysrhythmias, tissue Norepinephrine 1-15 min 2 mcg/kg/min 1 min 30 5 min hepatic n to effect mcg/kg/min mcg/kg/min mcg/kg/min necrosis, ischemia min 0.25 15- 0.25-0.5 0.25 3 15-30 Extravasation causes tissue Phenylephrine mcg/kg/min to 1-15 min 5 mcg/kg/min 1 min 30mi hepatic mcg/kg/min mcg/kg/min mcg/kg/min min necrosis effect n Do not increase rate 30- Vasopressin 0.01-0.04 0.04 without MD 5-15 10-20 Dysrhythmias, tissue 30-60 min N/A N/A 60 hepatic (septic shock) units/min units/min Order. Wean min min necrosis, ischemia off by 0.01 min unit/min .