Titrating Levophed

My hospital also uses non-weight based dosing for levophed. Our standard order was 2-30 mcg/min until recently when our health system went to 0-60 mcg/min. As juan pointed out, we also look for adding other pressors before reaching anywhere near max. I'll ask for vasopressin when we hit 10-12 mcg/min and then if we're still getting up into the 30-40 mcg/min range I'll ask about adding another pressor- usually neo or epinephrine, neo more often if the patient is tachycardic and epi might be ordered when we anticipate a patient may code, to reduce the interventions required during the code. Of course if the hypotension is cardiogenic shock related rather than septic shock, maybe we're looking at adding a dobutamine drip instead of straight pressors. 

We do mcg/kg/min and our max is .5.  But, if I was hitting .4 or .45 and staying there for a long time and only getting a MAP of 60-65 I’d start asking for Vaso.  

On 1/21/2021 at 12:09 PM, saz said:

Nanograms vs mg/ml? What are the major differences? What would be the conversion between the two? How high can you go when titrating mcg/kg/min before you want to start thinking about other options?

Thank you.

You should have parameters in your emar for titration? If you don't, they have to add them to your order, how else you're going to know what to do? Usually it's about keeping the map >65. However I have seen higher or lower MAP required. That's why it should be in your order. Usually other option is the addition of another pressor.