Levophed vs. Neo

[hell000nurse]

Hey all - wondering about how many of your facilities use levophed as 1st line defense for hypotension versus neosynephrine. I'm actually wondering why my MICU docs don't use neo more. I know that in general, levo is a go-to 1st ... but when you think of your septic patient who is already tachycardic from their fever, and hypotensive....why not go with the neo that will help increase the BP and decrease the HR?

thoughts/feelings? discuss :)

[joeyzstj, LPN]

For septic pts, we go straight to Levo first. Then Neo and then Vasopressin if needed. And if things really get ugly then we start on Epi.

This is how most of our surgeons prefer to run it as well. The anesthesiologist that I work with make little distinction between NEO and LEVOPHED. They seem to use Neo more for Anesthestic induced hypotension or hypotension in the presence of tachycardia. Levophed is our drug of choice for sepsis.

[RN1982]

We usually use levo in the SICU I work in. We also use it alone with vasopressin.

[meandragonbrett]

I am not 100% sure but the cardiothoracic surgeons use it on almost all of their open heart patients. It's usual concentration is 2 grams of (2 amps) epinephrine and 2 grams of calcium chloride in 250 mls of NS. Just look at the positive effects and actions and uses of both drugs and then combine them. It's funny though that particular drug is mixed either by anesthesia or ICU nurses, pharmacy won't mix it.

Did you mean milligram? 1 amp of epi is generally 1mg. We mix our epi/norepi gtts 8mg/250cc.

[ghillbert, MSN, NP]

Just look at the positive effects and actions and uses of both drugs and then combine them.

That's not really how pharmacology works...

It's funny though that particular drug is mixed either by anesthesia or ICU nurses, pharmacy won't mix it.

Sounds like a recipe for liability to me! Giving a non-approved drug cocktail that pharmacy refuses to mix? Wow.. I would not be anywhere near that order!

[NsgChica]

I work in an open heart icu, the cardiothoracic surgeons love to use Neo and Epi...Levophed isn't prescribed that often....wonder why?

[Iris Santana]

I think another situation which arises and plays an important role is products promotional events. Levophed may have invested in research clinical studies which have made quite an impression to the medical community. Either way Levo must be good . It has remained strong in the market.

[haji]

To try and answer the first question about sepsis.

One of the goals of early goal directed therapy in sepsis is improving o2 delivery.

Levophed does more to increase o2 delivery than neo, that's why its better for treating sepsis.

Neo is a pure alpha so it increases SVR

Levophed is an alpha and beta agonist, so you get a higher SVR and CO

[LeLeeFNP]

i thought dopamine was the strongest pressor. i know it causes significant tachycardia but this is what i have seen as first line in two of the ICUs i've worked in (CVICU and general ICU). Haven't seen much neo until recently. I have seen equal use of vasopressin and norepinephrine.

[APNgonnabe]

As far as why Neo isn't being used more...I think like one of the previous posters said it depends on the providers training. I worked in a busy/high acuity med/surg ICU w/ CABG pt and we used Neo often. To be fair we used dopamine and levo probably equally amongst all three. I do enjoy neo!!! I currently work in a community ICU and the providers do not seem to remember neo is an option. They have gotten on the levo band wagon from all the current sepsis recommendations.

[detroitdano]

I can't quite remember the hardcore physiology behind it, but doesn't Levo bind to some receptor site that bacterial cells compete for as well, Levo with a higher affinity? Maybe it was MDF, someone refresh me here.

[NtannRN]

Neo you can use peripherally, levo is always on a central line of some sort.

[lakemurray]

You cannot use neo peripherally!!!!