Levophed and Regitine

[misstofu]

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Hi,

Quick question: Have you ever used Levophed and Regitine together as a regimen to increase pt's blood pressure before?

Thereotically, Levophed is an alpha/beta agonist, Regitine is a alpha blocker, don't they suppose to have the opposite effect? Although there are physcians that still using them together to prevent tissue necrosis (extravasation) effect of levophed. What I learned from Rx school was that, Regitine can be given after such effect occurs but not together. Is this some sort of old medicine that I haven't heard of?

what pissed me off was when the dr. corrected me and said " you must recently graduated from Rx school " 👎

 

[december07]

we use it when we don't have a central line to run levophed. so, yeah, we do.

 

[xaelia]

I've never heard of combining phentolamine with norepinephrine before. Not sure I would bother doing it; by the time nurses figured out how to deal with the two drips, I could have, at the minimum, intraosseous access that would obviate the need for phentolamine.

Heck, the last time I ordered phentolamine, it came tubed up from pharmacy as a powder I had to reconstitute.

 

[njac]

I've had older physicians ask me about this - I believe they mix the phentolamine and norepi in the same bag if you have to run norepi into a peripheral vein, hopefully preventing local vasoconstriction so you can increase the rate of the pressor getting into systemic circulation.

Phentolamine is wicked expensive though.

 

[J ROD]

I work as an IV pharmacist some and never had been asked for that with an order....

 

[december07]

I work as an IV pharmacist some and never had been asked for that with an order....

It would not be an order to pharmacy.

It's in our CRASH Cart on the General medical floor for CODE BLUE. Regitine is a powder and you have to reconstitute it then mix it in the SAME bag with Levophed so you can run it in the same line. This is only on the floor cause those patients usually do not have a central line placement already. We ALWAYS attempt a central line first, and usually 99% successful. But when we can't get a central line in, we would run this mix first in a peripheral line while moving patient to the ICU. Out of all the code that we had, I've seen regitine used twice.

In the ED, we never had problem with central line. we usually have 99.999% success rate and if all else fail, we use our ultrasound machine which is readily available. This is why most ED physician never ever consider Regitine. I'm pretty sure once my internship is over, I'll do away with Regitine as well.

we're not that aggressive with intraosseous access for some reason. Like Xaelia said, if you have Intraosseous access, then why bother with this. Up until today, I have not done ONE intraosseous access during a code yet 🙂

 

[xaelia]

Up until today, I have not done ONE intraosseous access during a code yet 🙂

Interesting; IO is our code line, basically. Unless you're setting up ECMO, why muck around with needles/central line and risk of injury during CPR?

 

[njac]

Ive given NE through peripheral lines without phentolamine, of course it isn't ideal but you do what you have to in the meantime.

I'm yet to work anywhere that consistently places central lines during codes and in the ED.

 

[december07]

Ive given NE through peripheral lines without phentolamine, of course it isn't ideal but you do what you have to in the meantime.

I'm yet to work anywhere that consistently places central lines during codes and in the ED.

wait, just to clarify, we don't "consistently" place central lines during codes and in the ED. We only place it when we need multiple IV access, and often time, it's after the code and patient remains unstable in the ED or (or waiting for an ICU bed while patient remain on the floor)

sorry for the confusion.