neo vs norepi

SubSippi · Dec 11, 2014

It could definitely be the physician's preference. It would be easier to answer the question if I knew a little more about the patient.

Anyway, Levophed is much more powerful that Neo, so the physician might have thought the patient needed a stronger pressor than just Neo. Also, Levophed has positive inotropic properties, so if the hypotension was partially due to a low CO/CI, Levophed would probably be more effective.

Also, if the patient was hypotensive, it would make sense for them to be tachycardic. Hopefully the tachycardia would resolve once the blood pressure went up, so that may be why the doc wasn't worried about starting the patient on Levophed.

I work with cardiac drips pretty often, but am by no standards anywhere close to an expert. I'd love to hear some more input.

dah doh, BSN, RN · Dec 11, 2014

Usually doctors have preferences. Those are driven by patients condition though.

Why was the patient hypotensive & tachycardic? Was he hypovolemic, septic, acidotic, etc.

Answering the why might better lead to what pressor to use.

Da_Milk_of_Amnesia, MSN · Dec 12, 2014

Like everyone else said. For a better answer, we need a little more info.

eCCU · Jan 3, 2015

So, I'm pretty sure I've got the alpha/beta 1 and 2 stuff down but I still have a question. One of my patients was hypotensive with a MAP in the 50's with heart rate 120's. Doctor orders norepi. If my pt. was already tachy, why not neo? We use so much norepi and only once have I had a pt. on neo. Is it physician preference?
Thanks!
Michelle

Was the patient in septic shock? If so then SCCM recommends norepinephrine as the first line of therapy after fluid resuscitation had failed aka 1.5-3 liters.

Neosynephrine decreases SV and is only recommend as salvage therapy that is after 2 or more pressors have failed, pt had a high CO or norepinephrine has been evidenced to be a source of arrhythmia. ... there's is a whole long EBP on surviving sepsis.....so since you know the MOA here is the order....first line norepinephrine, epinephrine can be used as an alternative to norepinephrine. Vasopressin can be used in combination with norepinephrine but not alone, dopamine is reserved for only bradycardia patients and is not recommended for so called "renal protection" dobutamine can be used to increase CO after attaining MAP and still in a hypoperfusion state. ... hope this helps.....