Oral blood pressure augmenting agents for intravenous vasopressor weaning

Table 1 Pharmacology and overview of oral blood pressure augmenting agents

Agent	Onset	Half-life	Metabolism	Special considerations
Midodrine, desglymidodrine	1 hour	0.5 hour, 3-4 hours	Rapid deglycination to desglymidodrine	Avoid during bradycardia. Dose reductions necessary in renal dysfunction
Droxidopa	1 hour	2-3 hours	Metabolized to norepinephrine via the catecholamine pathway	Recent data suggests that capsule may be opened and administered via feeding tube
Pseudoephedrine	0.5 hour	3-16 hours1	Not substantially metabolized	Dose reductions should be considered in renal dysfunction
Atomoxetine	1 hour	5-24 hours2	Hepatic, cytochrome P4502D6 (major) and cytochrome P450 family 2 subfamily C member 19 (minor)	Avoid during agitated delirium. Dose reductions necessary in hepatic dysfunction

¹Half-life prolonged with elevated urine potentiel d'hydrogène.

²Half-life prolonged in cytochrome P4502D6 poor metabolizers.