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ClearRounds Health · Cardiology · Quick Reference
ICU Drips for Cardiology
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ICU, Shock & EmergenciesAdvancedIn progressOne-page PDF
Category-organized cardiology ICU/CCU drip sheet — vasopressors, inotropes/inodilators, antiarrhythmics, vasodilators/antihypertensives, and antithrombotic drips — with typical adult dose ranges, effects, and pearls.
Last reviewed
June 12, 2026
Sources / guidelines to verify
- Institutional ICU drip protocols & pharmacy references
- AHA Scientific Statement on Cardiogenic Shock
- ACLS; relevant ACC/AHA guidelines (ACS, AF) for antithrombotic/antiarrhythmic dosing
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.
One-page reference
Clinically reviewed by the site owner. Still verify against the sources above and local protocol before clinical use.
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How to use this
- Match the agent to the problem: define the shock type first — vasodilatory (“warm,” low SVR) vs cardiogenic (“cold,” low output) vs mixed.
- Vasopressors raise pressure (SVR); inotropes raise output; inodilators do both but drop SVR (can lower BP); antiarrhythmics fix rate/rhythm.
- Doses below are typical adult ranges, in mcg/kg/min unless noted. Always verify against your ICU protocol and pharmacy before use.
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1 · Vasopressors — raise blood pressure (SVR)
| Agent | Typical adult dose | Effect (receptor) | Use / pearl |
|---|---|---|---|
| Norepinephrine (Levophed) | 0.01–1 mcg/kg/min | ↑SVR, modest ↑CO (α₁>β₁) | First-line for most shock incl. cardiogenic with vasoplegia; preferred over dopamine (SOAP II) |
| Epinephrine | 0.01–0.5 mcg/kg/min | ↑CO, ↑HR, ↑SVR (β+α) | Post-arrest, anaphylaxis, refractory shock; raises lactate, arrhythmogenic |
| Phenylephrine (Neo-Synephrine) | 0.1–1.5 mcg/kg/min | Pure α₁ ↑SVR, reflex ↓HR | Hypotension with tachyarrhythmia; peri-procedural; push-dose 50–200 mcg |
| Vasopressin | 0.03 units/min (fixed) | V₁ ↑SVR, catecholamine-sparing | Add-on in vasodilatory shock; do NOT titrate to HR |
| Dopamine | 5–20 mcg/kg/min | Dose-dependent ↑HR/CO → ↑SVR | Bradycardia/shock; more arrhythmogenic — largely replaced by norepinephrine |
| Angiotensin II (Giapreza) | start 20 ng/kg/min | ↑SVR (RAAS) | Refractory vasodilatory shock add-on |
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2 · Inotropes & inodilators — raise cardiac output
| Agent | Typical adult dose | Effect | Use / pearl |
|---|---|---|---|
| Dobutamine | 2–20 mcg/kg/min | β₁ ↑contractility/CO, ↓SVR | Low-output/cardiogenic shock; watch hypotension & tachycardia |
| Milrinone (Primacor) | 0.125–0.75 mcg/kg/min | PDE-3 inodilator: ↑CO, ↓SVR/PVR | Low-output HF, RV failure/PH; renally cleared, causes hypotension; often no bolus |
| Epinephrine (low-dose) | 0.01–0.1 mcg/kg/min | β-predominant ↑CO/HR | Inotropy when you also need some pressor support |
- Inodilators (dobutamine, milrinone) lower SVR — if the patient is hypotensive, pair with a vasopressor (e.g., norepinephrine).
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3 · Antiarrhythmics — rate & rhythm
| Agent | Typical adult dose | Class / action | Use / pearl |
|---|---|---|---|
| Amiodarone | 150 mg over 10 min → 1 mg/min ×6h → 0.5 mg/min | Broad (K/Na/Ca/β) | VT/VF, AF/flutter; hypotension if pushed fast; phlebitic — central line preferred |
| Lidocaine | 1–1.5 mg/kg bolus → 1–4 mg/min | Na-channel (Ib) | Ventricular arrhythmias (esp. ischemic); watch CNS toxicity, reduce in hepatic/low-output |
| Diltiazem (Cardizem) | 0.25 mg/kg bolus → 5–15 mg/h | Non-DHP CCB | Rate control in AF/flutter; AVOID in HFrEF / decompensated HF (negative inotrope) |
| Esmolol | (load 500 mcg/kg) 50–200 mcg/kg/min | β₁ (ultra-short) | Titratable rate control / ↓ shear in dissection; wears off fast if it’s not tolerated |
| Procainamide | 20–50 mg/min load → 1–4 mg/min | Na-channel (Ia) | Stable wide-complex VT, pre-excited AF; stop if QRS widens >50% or hypotension |
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4 · Vasodilators & antihypertensives — reduce afterload / BP
| Agent | Typical adult dose | Effect | Use / pearl |
|---|---|---|---|
| Nitroglycerin | 5–200 mcg/min | Venodilator ↓preload (coronary dilation) | ACS, ADHF, flash pulmonary edema; avoid if preload-dependent, RV infarct, or recent PDE5 inhibitor |
| Nicardipine (Cardene) | 5–15 mg/h | DHP CCB ↓SVR | Hypertensive emergency; smooth, predictable titration |
| Clevidipine (Cleviprex) | 1–2 mg/h (↑ to ~32) | Ultra-short DHP CCB ↓SVR | Rapid, tight BP control; lipid emulsion — avoid in egg/soy allergy |
| Nitroprusside | 0.3–10 mcg/kg/min | Arterial + venous ↓afterload | Severe HTN/afterload; cyanide/thiocyanate risk with prolonged or renal/hepatic use |
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5 · Anticoagulants & antithrombotics (drips)
| Agent | Typical adult dose | Class | Use / pearl |
|---|---|---|---|
| Heparin (UFH) | Weight-based per indication (e.g. ACS ~60 u/kg bolus, 12 u/kg/h) | Antithrombin-mediated | ACS, AF, VTE, intracardiac thrombus; follow aPTT or anti-Xa; reversible with protamine |
| Bivalirudin (Angiomax) | 0.75 mg/kg bolus → 1.75 mg/kg/h | Direct thrombin inhibitor | PCI; option in HIT |
| Argatroban | 0.5–2 mcg/kg/min | Direct thrombin inhibitor | HIT; hepatically cleared (↑INR — care when bridging to warfarin) |
| Eptifibatide (Integrilin) / tirofiban (Aggrastat) | eptifibatide 180 mcg/kg ×2 → 2 mcg/kg/min | GP IIb/IIIa inhibitor | High-risk ACS/PCI with large thrombus burden; reduce/avoid in renal failure; bleeding/thrombocytopenia risk |
| Cangrelor (Kengreal) | 30 mcg/kg bolus → 4 mcg/kg/min | IV P2Y12 inhibitor | PCI bridge / when oral antiplatelet not feasible; offset in ~1 h |
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6 · Other cardiology-ICU drips
- Isoproterenol (Isuprel) 0.01–0.1 mcg/kg/min — β-agonist chronotrope for refractory bradycardia / sinus node dysfunction, torsades or long-QT bridge, and the denervated post-transplant heart. Pearl: β₂ vasodilation raises rate without raising BP (often lowers it), so it is especially useful when a patient is bradycardic but hypertensive — where epinephrine or dopamine would push the pressure higher.
- Continuous loop diuretic — furosemide 5–20 mg/h (or bumetanide) after an IV bolus for diuretic-resistant ADHF.
- Inhaled pulmonary vasodilators — epoprostenol or nitric oxide for RV failure / pulmonary hypertension and post-cardiotomy RV support.
- Push-dose pressors — phenylephrine 50–200 mcg or epinephrine 5–20 mcg IV for transient hypotension while a drip is being set up (verify local recipe).
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Pearls & safety
- Central access is preferred for vasopressors; an arterial line aids titration. Norepinephrine may be run peripherally short-term per protocol.
- Inotropes/inodilators raise myocardial O₂ demand and arrhythmia risk — use the lowest effective dose.
- Do not rely on a pure vasoconstrictor (phenylephrine, vasopressin) in low-output shock without addressing contractility.
- Avoid non-dihydropyridine rate agents (diltiazem) in decompensated HFrEF; reach for amiodarone or digoxin instead.
Dosing safety
- Doses are typical adult ranges and vary by weight, indication, and institution — verify every drip against your ICU protocol and pharmacy reference before use.
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Red flags / escalate now
- Escalating vasopressor requirement, rising lactate, or end-organ failure → consider mechanical circulatory support and transfer.
- Vasopressor extravasation → treat per protocol (e.g., phentolamine).
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Sources to verify
- Institutional ICU drip protocols & pharmacy references
- AHA Scientific Statement on Cardiogenic Shock
- ACLS; relevant ACC/AHA guidelines (ACS, AF) for antithrombotic/antiarrhythmic dosing
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