Tachyphylaxis to Norepinephrine: Clinical Implications and Management

Introduction to Tachyphylaxis Management

• The American Heart Association recommends adding alternative vasopressors like vasopressin when persistent hypotension occurs despite epinephrine and fluids, as stated in the 2010 guidelines 1
• The perioperative anaphylaxis consensus also recommends adding alternative vasopressors like vasopressin, as stated in the 2019 consensus 2

Management Strategy

• Early addition of vasopressin, ideally within 3-4 hours of shock onset, produces better outcomes in terms of time to shock resolution and ICU length of stay, although the exact citation for this specific timeframe is not provided, the 2010 AHA guidelines and 2019 perioperative anaphylaxis consensus support the use of alternative vasopressors like vasopressin 1, 2