Robinson JC, ElSaban M, Smischney NJ, Wieruszewski PM. Oral blood pressure augmenting agents for intravenous vasopressor weaning. World J Clin Cases 2024; 12(36): 6892-6904 [PMID: 39726934 DOI: 10.12998/wjcc.v12.i36.6892]
Corresponding Author of This Article
Patrick M Wieruszewski, PharmD, Assistant Professor, Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. wieruszewski.patrick@mayo.edu
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2024; 12(36): 6892-6904 Published online Dec 26, 2024. doi: 10.12998/wjcc.v12.i36.6892
Oral blood pressure augmenting agents for intravenous vasopressor weaning
John C Robinson, Mariam ElSaban, Nathan J Smischney, Patrick M Wieruszewski
John C Robinson, Department of Pharmacy, Mayo Clinic, Phoenix, AZ 85054, United States
Mariam ElSaban, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, United States
Nathan J Smischney, Patrick M Wieruszewski, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
Patrick M Wieruszewski, Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Robinson JC, ElSaban M, Smischney NJ, and Wieruszewski PM performed the literature search, created the figures, drafted the paper, and reviewed and edited the manuscript and approved the final version to be published.
Conflict-of-interest statement: Wieruszewski PM is a consultant for Wolters Kluwer/UpToDate. All other authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Patrick M Wieruszewski, PharmD, Assistant Professor, Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. wieruszewski.patrick@mayo.edu
Received: June 19, 2024 Revised: September 28, 2024 Accepted: October 21, 2024 Published online: December 26, 2024 Processing time: 133 Days and 18.1 Hours
Abstract
Intravenous (IV) vasopressors are essential in the management of hypotension and shock. Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice. While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose, its adverse effect profile may preclude its use in certain populations. In addition, some patients may require persistent use of IV vasopressors for hypotension refractory to midodrine. The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging. This article provides a comprehensive review of the pharmacology, clinical uses, dosing strategies, and safety considerations of oral vasoactive agents and their application in the intensive care setting.
Core Tip: This paper sets to explore the evolving role of oral blood pressure augmenting agents in the intensive care setting. With their ability to increase blood pressure through direct or indirect vasoconstriction, these agents have been increasingly utilized to facilitate weaning from intravenous (IV) vasopressors. Use of these agents may have a role in reducing IV vasopressor exposure, intensive care unit lengths of stay, and overall healthcare resource utilization. Despite being commonly used, their role in practice should be tempered by lack of demonstrable efficacy in major trials and important adverse effect considerations.
