Phenylephrine and ephedrine

Phenylephrine is a strong vasopressor, primarily affecting a receptors, with some b activity at very high doses. Thus phenylephrine may increase the heart rate even less than norepinephrine.

Ephedrine is a potent non-selective vasopressor with clinical effects similar to those of epinephrine. It has direct adrenoceptor action and also enhances the release of endogenous norepinephrine from sympathetic nerve endings. It has a longer duration of action than the catecholamines and has central nervous system stimulant effects which can be disturbing.

In small studies on septic patients these agents have been shown to increase arterial pressure, but they have little to offer over other vasopressors. These very strong vasopressors have little place in ICU therapy except perhaps transiently in very severe refractory hypotension.

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