Compare drugs side-by-side

Pick 2-5 drugs to compare mechanism, dosing, PK, hemodynamics, side effects, and pearls. Useful for picking between induction agents, vasoactives, or NMBAs.

	Phenylephrine	Norepinephrine Levophed
Class	Synthetic α1-agonist	Endogenous catecholamine, α1 > β1 agonist
Mechanism	Pure α1 agonist → vasoconstriction. No β activity.	Strong α1 → vasoconstriction. Mild β1 → modest inotropy. Minimal β2.
Indications	· Anesthesia-induced hypotension · OB spinal hypotension (preferred over ephedrine for fetal pH) · Mydriasis (ophthalmic)	· Septic shock (first-line) · Vasoplegic shock post-bypass · Distributive shock · Anesthesia-induced hypotension (refractory)
Dosing	Bolus: 50–200 mcg IV Infusion (general OR): 0.15–1.5 mcg/kg/min OB spinal prophylaxis (SOAP 2018): 25–50 mcg/min infusion at spinal placement; titrate to baseline SBP; OR variable-rate 50 mcg bolus PRN	Infusion: 0.01–1 mcg/kg/min (titrated to MAP)
PK (onset / duration)	Onset 1 min. Duration 10–20 min.	Onset seconds. Duration < 5 min after infusion stop.
Hemodynamics	↑SVR, ↑BP. Reflex bradycardia (often ↓CO).	↑SVR, ↑BP, slight ↑CO. Reflex bradycardia rare.
Respiratory	—	—
Side effects	· Bradycardia + ↓CO (relevant in poor LV function) · Reduced uteroplacental flow at high dose	· Distal ischemia (digits, mesenteric — especially with high-dose, prolonged) · Extravasation necrosis — treat with phentolamine · Reduced renal/splanchnic perfusion at high dose
Contraindications	· Severe LV dysfunction (relative — reduced CO with vasoconstriction)	· Hypovolemic shock without volume resuscitation (relative)
Reversal	—	—
Pearls	· OB spinal: phenylephrine maintains umbilical artery pH better than ephedrine. · Cardiac surgery off-pump: phenyl preferred for systemic pressure during graft anastomoses. · Watch for reflex bradycardia in LVH/HOCM patients.	· Surviving Sepsis: NE first-line, MAP target ≥ 65. · Central line preferred but a peripheral 18g + close monitoring acceptable for short courses (recent literature).

Common compares

Propofol vs Etomidate vs Ketamine Sux vs Roc vs Cis Fentanyl vs Remi Phenylephrine vs Norepi Volatiles

Cells showing "—" indicate the drug doesn't have a detail entry for that field yet (most drugs do; some legacy class members haven't been fully populated). Education only — verify dosing against package insert + institutional protocol before bedside use.

Compare drugs side-by-side

Pick 2-5 drugs to compare mechanism, dosing, PK, hemodynamics, side effects, and pearls. Useful for picking between induction agents, vasoactives, or NMBAs.

	Phenylephrine	Norepinephrine Levophed
Class	Synthetic α1-agonist	Endogenous catecholamine, α1 > β1 agonist
Mechanism	Pure α1 agonist → vasoconstriction. No β activity.	Strong α1 → vasoconstriction. Mild β1 → modest inotropy. Minimal β2.
Indications	· Anesthesia-induced hypotension · OB spinal hypotension (preferred over ephedrine for fetal pH) · Mydriasis (ophthalmic)	· Septic shock (first-line) · Vasoplegic shock post-bypass · Distributive shock · Anesthesia-induced hypotension (refractory)
Dosing	Bolus: 50–200 mcg IV Infusion (general OR): 0.15–1.5 mcg/kg/min OB spinal prophylaxis (SOAP 2018): 25–50 mcg/min infusion at spinal placement; titrate to baseline SBP; OR variable-rate 50 mcg bolus PRN	Infusion: 0.01–1 mcg/kg/min (titrated to MAP)
PK (onset / duration)	Onset 1 min. Duration 10–20 min.	Onset seconds. Duration < 5 min after infusion stop.
Hemodynamics	↑SVR, ↑BP. Reflex bradycardia (often ↓CO).	↑SVR, ↑BP, slight ↑CO. Reflex bradycardia rare.
Respiratory	—	—
Side effects	· Bradycardia + ↓CO (relevant in poor LV function) · Reduced uteroplacental flow at high dose	· Distal ischemia (digits, mesenteric — especially with high-dose, prolonged) · Extravasation necrosis — treat with phentolamine · Reduced renal/splanchnic perfusion at high dose
Contraindications	· Severe LV dysfunction (relative — reduced CO with vasoconstriction)	· Hypovolemic shock without volume resuscitation (relative)
Reversal	—	—
Pearls	· OB spinal: phenylephrine maintains umbilical artery pH better than ephedrine. · Cardiac surgery off-pump: phenyl preferred for systemic pressure during graft anastomoses. · Watch for reflex bradycardia in LVH/HOCM patients.	· Surviving Sepsis: NE first-line, MAP target ≥ 65. · Central line preferred but a peripheral 18g + close monitoring acceptable for short courses (recent literature).