Methylene blue, midodrine, and pseudoephedrine: a review of alternative agents for refractory hypotension in the intensive care unit.
Hypotensive episodes are common among patients in the intensive care unit and can lead to multiorgan failure if uncontrolled. Fluid administration and continuous infusion of vasoactive agents are frequently used for management of hypotension; however, both therapies may be associated with adverse effects including pulmonary edema and tissue necrosis. In addition, availability of these first-line agents has been impacted by the increasing occurrence of drug shortages. Methylene blue, pseudoephedrine, and midodrine have been considered potential alternatives to standard therapy. These agents may not only be used when first-line agents are unavailable due to shortages, but they may also aid in reducing the cumulative dose of other vasoactive agents used. The purpose of this review was to discuss strategies for the safe and effective use of methylene blue, pseudoephedrine, and midodrine for the treatment of hypotension in the critically ill.
Emergency Medicine (Dr Van Berkel), and Neurocritical Care (Dr Jones), Methodist Healthcare-University Hospital, Memphis, Tennessee; Clinical Pharmacy (Dr Van Berkel), Pharmacy Department (Dr Fuller), College of Nursing (Dr Alexandrov), and Clinical Pharmacy, Neurology, and Neurosurgery (Dr Jones), University of Tennessee Health Sciences Center, Memphis, Tennessee; Health Outcomes Institute, Fountain Hills, Arizona (Dr Alexandrov); and Australian Catholic University-Sydney, Sydney, Australia (Dr Alexandrov).
Megan A
MA
Van Berkel
Laura A
LA
Fuller
Anne W
AW
Alexandrov
G Morgan
GM
Jones
D064648:Critical Care Nursing; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008751:Methylene Blue / Q000627:therapeutic use*; D008879:Midodrine / Q000627:therapeutic use*; D054199:Pseudoephedrine / Q000627:therapeutic use*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D004791:Enzyme Inhibitors; D014662:Vasoconstrictor Agents; D008879:Midodrine; D054199:Pseudoephedrine; D008751:Methylene Blue