Inotropes and vasopressors

Key points

These guidelines are recommended for dosing, preparing and centrally administering inotropes and vasopressors in adults.

If central venous access is not possible, peripheral administration should be commenced in consultation with a critical care service, ARV or the tertiary referral hospital.

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On this page

Please note that this guidance is currently undergoing review by Safer Care Victoria to ensure the content is up to date. In the meantime, we recommend that you also refer to more contemporaneous evidence where possible.

Prescribing guide

The table below is an easy-to-follow prescribing guide for emergency clinicians to use when managing patients who require inotropes and vasopressors.

Click on the links for more detailed information on each medication.

Inotrope and vasopressor guidelines
Medication	Prescribe	Make infusion using	Volume to be removed from bag	Suggested dosing range
Adrenaline (epinephrine) 1 mg/1 mL vials (1:1000)	6 mg in 100 mL 12 mg in 200 mL	100 mL bag glucose 5% 250 mL bag glucose 5%	6 mL 62 mL	Starting dose: 1 - 4 microg/minute Usual dose range: 1 – 20 microg/minute
Argipressin (vasopressin) 20 units/1 mL vials	Via syringe driver: 20 units in 20 mL 40 units in 40 mL	Draw up 19 mL glucose 5% Draw up 38 mL glucose 5%	N/A N/A	Starting dose: 0.6 units/hour Usual dose range: 0.6 – 2.4 Units/hour
Dobutamine 250 mg/ 20 mL vials	250 mg in 42 mL 500 mg in 83 mL	50 mL bag glucose 5% 100 mL bag glucose 5%	28 mL 57 mL	Starting dose: 100 – 400 microg/minute Usual dose range: 100 – 1500 microg/minute
Dopamine 200 mg/ 5 mL vials	300 mg in 50 mL 600 mg in 100 mL	50 mL bag glucose 5% 100 mL bag glucose 5%	7.5 mL 15 mL	Starting dose: 100 – 400 microg/minute Usual dose range: 100 – 1500 microg/minute
Isoprenaline 1 mg/ 5 mL vials	6 mg in 100 mL	100 mL bag glucose 5%	30 mL	Starting dose: 0.5 – 2 microg/minute Usual dose range: 2 – 10 microg/minute
Levosimendan 12.5 mg/ 5 mL vials	12.5 mg in 250 mL	250 mL bag glucose 5%	5 mL	Usual dose range: 0.05 – 0.2 microg/kg/minute
Metaraminol 10 mg/ 1 mL vials	Incremental IV bolus: 10 mg in 20 mL Via syringe driver: 20 mg in 40 mL	Draw up 19 mL glucose 5% Draw up 38 mL glucose 5%	N/A N/A	Usual dose range: 0.5 – 10 mg/hour
Milrinone 10 mg/ 10 mL vials	Via syringe driver: 10 mg in 50 mL Via infusion pump: 20 mg in 100 mL	Draw up 40 mL glucose 5% 100 ml bag glucose 5%	N/A 20 mL	Starting dose: 0.1 microg/kg/minute Usual dose range: 0.125 – 0.75 microgram/kg/minute
Noradrenaline (norepinephrine) 2 mg/ 2 mL vials	4mg in 66mL 6mg in 100 mL 16 mg in 266 mL	100mL bag glucose 5% 100 mL bag glucose 5% 250 mL bag glucose 5%	38mL 6 mL Nil	Starting dose: 2 – 10 microg/minute Usual dose range: 0.5 - 30 microg/minute

Inotrope and vasopressor guidelines

Medication

Prescribe

Make infusion using

Volume to be removed from bag

Suggested dosing range

Adrenaline (epinephrine)

1 mg/1 mL vials

(1:1000)

6 mg in 100 mL

12 mg in 200 mL

100 mL bag glucose 5%

250 mL bag glucose 5%

6 mL

62 mL

Starting dose:
1 - 4 microg/minute

Usual dose range:
1 – 20 microg/minute

Argipressin
(vasopressin)

20 units/1 mL vials

Via syringe driver:
20 units in 20 mL

40 units in 40 mL

Draw up 19 mL glucose 5%

Draw up 38 mL glucose 5%

N/A

Starting dose:
0.6 units/hour

Usual dose range:
0.6 – 2.4 Units/hour

Dobutamine

250 mg/ 20 mL vials

250 mg in 42 mL

500 mg in 83 mL

50 mL bag glucose 5%

100 mL bag glucose 5%

28 mL

57 mL

Starting dose:
100 – 400 microg/minute

Usual dose range:
100 – 1500 microg/minute

Dopamine

200 mg/ 5 mL vials

300 mg in 50 mL

600 mg in 100 mL

50 mL bag glucose 5%

100 mL bag glucose 5%

7.5 mL

15 mL

Starting dose:
100 – 400 microg/minute

Usual dose range:
100 – 1500 microg/minute

Isoprenaline

1 mg/ 5 mL vials

6 mg in 100 mL

100 mL bag glucose 5%

30 mL

Starting dose:
0.5 – 2 microg/minute

Usual dose range:
2 – 10 microg/minute

Levosimendan

12.5 mg/ 5 mL vials

12.5 mg in 250 mL

250 mL bag glucose 5%

5 mL

Usual dose range:
0.05 – 0.2 microg/kg/minute

Metaraminol

10 mg/ 1 mL vials

Incremental IV bolus:
10 mg in 20 mL

Via syringe driver:
20 mg in 40 mL

Draw up 19 mL glucose 5%

Draw up 38 mL glucose 5%

N/A

Usual dose range:
0.5 – 10 mg/hour

Milrinone

10 mg/ 10 mL vials

Via syringe driver:
10 mg in 50 mL

Via infusion pump:
20 mg in 100 mL

Draw up 40 mL glucose 5%

100 ml bag glucose 5%

N/A

20 mL

Starting dose:
0.1 microg/kg/minute

Usual dose range:
0.125 – 0.75 microgram/kg/minute

Noradrenaline
(norepinephrine)

2 mg/ 2 mL vials

4mg in 66mL

6mg in 100 mL

16 mg in 266 mL

100mL bag glucose 5%

100 mL bag glucose 5%

250 mL bag glucose 5%

38mL

6 mL

Nil

Starting dose:
2 – 10 microg/minute

Usual dose range:
0.5 - 30 microg/minute

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Background

Inotropes and vasopressors are vital medicines that are commonly used to treat the heart – mostly in our hospitals’ intensive care units (ICUs) or critical care units (CCUs).

Research shows the way they are used varies significantly between health services.

To help reduce medication errors and support consistent, high-quality care for all Victorian patients, we have released standardised guidelines on how centrally administered inotropes and vasopressors are prepared, dosed and administered.