What's up with LEVOPHED?

[TomB]

We've probably all heard "Levophed, leave 'em dead"

Since Levo constricts blood vessels, extremities are the first effected. We had a patient in neuro icu for so long on levo that her fingers turned black and one of them actually broke off. They should have let that woman die long before that happened.

[CaseyLynn.ER.RN]

I did a research paper on necrotizing fasciitis and saw horrid pics of after effects of levo. Ironically two months later, my aunt developed severe abd pain that was disproportionate to the small discoloraton on her abd. Long story short, she had nf and was intubated and on levo in less than 12 hours. Multiple days and surgeries later, I was freaking out-she was still on levophed... Here I am half a continent away and not able to be with her, and I'm thinking the worst. She made it out with all her toes and fingers. She is disfigured from abd through genitals and down to her thighs, but she is going back to full time work this fall and is doing great. Without levo, she would probably not be here with us today!

[dreamcatchercrna]

Baxter drug company when bringing dopamine into the ICU promoted the beta strength of their product. By increasing strength of contraction there was better perfusion than the venoconstriction of levophed. By the way, dopamine received FDA approval as a diuretic not as a vasopressor. The truth is that levophed is a better drug with less tachycardia. The strength of contraction is equal if not better. It is better to keep up than catch up. Perfusion and prevention of Systemic inflammatory response syndrome with its cytokine release is paramount in preventing multi-organ system failure. The use of dopamine early caused levophed to be used as a last ditch drug where it was to late to save the pt. Early use at 100 mcg/kg/min titration up or down depending on response is a better option in the critical pt.

[ERRNCEN]

ACEP American College of Emergency Physicians has a great dosing card for Levophed, Epi, Dopamine and Dobutamine. Check it out on ACEP Bookstore - Dose Right Card Adult Vasopressors/Inotropes