Metaraminol in critical care and anesthesia: A safe alternative for hypotension management?
Year: 2025
Type: article
Abstract: Metaraminol, a synthetic sympathomimetic amine with predominant alpha-1 adrenergic agonist activity, is increasingly used to manage arterial hypotension in critical care and anesthesia. Its pharmacological effects include peripheral vasoconstriction and indirect stimulation of norepinephrine release, producing effective hemodynamic support through intravenous bolus or infusion. Compared with norepinephrine, metaraminol may offer advantages such as reduced arrhythmogenic potential, improved coronary and renal perfusion, and suitability for peripheral administration, minimizing risks associated with central venous access. However, evidence supporting its broader use outside obstetric anesthesia remains limited, largely derived from small observational studies. Uncertainties persist regarding optimal dosing, pharmacokinetic variability, and dose equivalence with norepinephrine. Reported adverse effects include prolonged hypertension, tissue ischemia, and reflex bradycardia. Despite these gaps, surveys indicate widespread clinical use, reflecting its practicality for rapid hemodynamic stabilization. Current data suggest non-inferiority to norepinephrine in obstetric anesthesia, but robust randomized trials are needed to define efficacy, safety, and pharmacodynamic profiles across patient populations. Standardization of dosing strategies and further evaluation in critical care settings are essential to clarify metaraminol’s role as a safe and effective vasopressor alternative.
Source: Clinical Critical Care
Authors: Camila Gomes Dall’Aqua, Bruno Vinícius Castello Branco, André Luis Vieira Drumond, Marina Ayres Delgado
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415912981