Is there a max dose of Levophed?

Specialties MICU

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Several of my coworkers are convinced that giving anything greater than 30 mcg/min is pointless. Most books I have read state that 30 mcg/min is the max dose. However, I have also seen doses that were higher and in some cases much higher than 30mcg/min. Is there a max dose of levophed? What would be the problem of using more than 30 mcg/min? Can doses greater than 30mcg/min be therapeutic? Is there a dose where levophed just stops being effective or does this depend on the patient?

Thanks,

Kevin

Specializes in trauma ICU,TNCC, NRP, PALS, ACLS.

I was wondering why some of the nurses where whispering "levophed leave em dead"... I had a pt on levophed and I stopped after 30mcg and told the doc that i had max out on levoped, so he added a vasopressin 0.02 then the dude max out on vaspressin.

Back in the day, before Levophed was first line for sepsis, we called it "leave 'em dead" or "dead in the bed" and was a last resort drug. Just be smart about it.
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Our facility policy says 100mcg/min of norepi. We routinely use higher dosages. Just depends on what the patient needs and what's going on.

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Specializes in SICU/Trauma.

As with anything in nursing each doc and facility is different. At our facility we say our "max" dose is 1 mcg/kg/min or 12mcg/min. Which from what others are saying is low, I have ran it higher before but you must think once you get to a certain dose and its not working it is time to think to start something else whether it be neo or vaso. You have to look at the patient to decide but thats usually my rule of thumb, start something else if you are maxed and it is not working. I hope that helps. :loveya:

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Most of the drug books state .18mg/min or 180mcg/min is the max dose for sever hypo or sepsis. Go by your hospital guidlines. That will be your best bet, and it also gives you cover if anything comes from the death of a pt. It is always best to follow the hospital protocol. Hope that this helps.

Navy Nurse Corp

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Our ICU pharmacist ( who is absolutely wonderful and know everything ) has had this discussion quite a bit with us. There is really no "max" dose of levophed, but if a person is septic they will more likely respond to vasopression.

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Specializes in SICU.

Wow, I saw a patient today on 200 mcg/min of levo! I had no idea just how high that was until I started reading this post :-)

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Specializes in critical care.
As with anything in nursing each doc and facility is different. At our facility we say our "max" dose is 1 mcg/kg/min or 12mcg/min. Which from what others are saying is low, I have ran it higher before but you must think once you get to a certain dose and its not working it is time to think to start something else whether it be neo or vaso. You have to look at the patient to decide but thats usually my rule of thumb, start something else if you are maxed and it is not working. I hope that helps. :loveya:

I too agree that that is a VERY low dose of levo. I think that tho some of the posts are really keying in on the severe sepsis pt. We have run levo obviously wide-open with severe hypotension, while initiating vaso at max dose. This of course is not for long term..just get the patient stabilized. Most patients tho, that have such high doses administered are not going to survive, it doesn't matter what else is initiated. Our usual concentration is 8mg/250cc, but for those that are receiving high doses we will mix 16mg/250. It just depends. We really have no policy that states how high you can go with Levo. It states: "Titrate for pt response/physician parameters."

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Specializes in critical care.
I was wondering why some of the nurses where whispering "levophed leave em dead"... I had a pt on levophed and I stopped after 30mcg and told the doc that i had max out on levoped, so he added a vasopressin 0.02 then the dude max out on vaspressin.

they used to say that because of the side effects associated with high dose Levo. ie: Kidney failure (of course hypotension will cause that too!), necrotic fingers/toes etc. It will completely clamp down the peripheral vasculature in order to raise BP, you can definately sacrifice other body systems with this, or risk amputation of limbs....it all depends on how far the patient/family wants to go in order to "survive"

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Specializes in ICU.

We had a pt with necrotising fasciitis, very sick. She was on norardrenaline, quad strenth i.e. 320mcgs per ml, running at 20mls per hour, plus dobutamine and vasopressin. We were doing continual cardiac output studies and titrating the drugs according to her response.

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I happened to see this and it has been like what? 4 years?! Lol. Anyway, in our institution we use weight based computations and accdg to pharmacology literature levophed shouldn't be given more than 2 mcg/kg/min but as per experience, I have never reached 2 mcg/kg/min in my titration for the usual patients. The highest so far that I have reached was 0.8mcg/kg/mun. I just had 1 patient who we gave the max dose of 2. She was terminal already and we had to max out our drips to the point where the family would reach acceptance.

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