The Beta-1 Inotrope
Inodilator for cardiogenic shock and sepsis-induced cardiogenic shock. Increases CO and decreases SVR. Often requires concomitant Norepinephrine due to hypotension risk.
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Mechanism: Predominantly (Inotropy/Chronotropy). Mild (Vasodilation).
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Dosing: Cardiogenic Shock: 2.5-20 mcg/kg/min. Sepsis-Induced Cardiogenic Shock: Add to Norepinephrine when myocardial dysfunction present.
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PK: Onset: 1–2 mins. Half-life: 2 mins.
indications
- Cardiogenic Shock – Primary indication
- Sepsis-Induced Cardiogenic Shock (SICS) – Add to Norepinephrine for myocardial dysfunction
evidence & efficacy
- Sepsis: SSCG Guidelines suggest adding to norepi for myocardial dysfunction, but outcomes data is neutral (no clear mortality benefit).
- Comparison: No significant difference in outcomes compared to Milrinone in cardiogenic shock.
cautions
- Hypotension: The effect can drop BP, especially in hypovolemia. Usually requires concomitant Norepinephrine
- Arrhythmias: Increases AV conduction; risk of AFib RVR / VT
- Tachyphylaxis: Beta-receptors downregulate after ~48-72 hours, reducing efficacy.