Drip & vasopressor calculator
Two-way dose ↔ mL/h conversion for vasopressor and inotrope infusions, with label dosing ranges, and a norepinephrine-equivalent total across concurrent pressors.
1Drug
2Concentration
Tap the bag you are using (common premixes — check your pharmacy's standard), or type drug amount and volume.
3Patient
4Dose ↔ rate
Type in either box — the other updates.
5Norepinephrine equivalents
Concurrent pressors → one number (Kotani 2023). Uses the weight above for mcg/min entries.
How it works
Conversion formulas
Bag volume here is the labelled final volume; overfill and line dead space are ignored. Concentrations printed on premixed bags are the ones to use.
Norepinephrine equivalent (NEE) formula
This tool uses the updated formula of Kotani et al. (Crit Care 2023; metaraminol factor corrected 2025):
NEE (mcg/kg/min) = norepinephrine + epinephrine + dopamine ÷ 100 + 0.06 × phenylephrine (all mcg/kg/min) + 2.5 × vasopressin (units/min) + 0.0025 × angiotensin II (ng/kg/min)Basis: epinephrine ≈ norepinephrine (equal doses to the same MAP in RCTs); dopamine 1/100 (SOAP II); phenylephrine 0.06 (3.2 mcg/kg/min ≈ 0.2 norepinephrine); vasopressin 2.5 (0.03 units/min spared ~7.5 mcg/min norepinephrine in VASST); angiotensin II 0.0025 (20 ng/kg/min spared 0.05 mcg/kg/min in ATHOS-3).
Goradia 2021 differs: phenylephrine ÷10 and angiotensin II 10 × dose in mcg/kg/min (equivalent to 0.01 per ng/kg/min — 4× Kotani). Report which formula you used.
Limits: conversion ratios rest on sparse data; NEE ignores inotropes (dobutamine, milrinone) and mechanical support, so it understates total hemodynamic support in cardiogenic shock. It describes vasopressor exposure; it is not a dosing target.
Label dosing at a glance
| Drug | Label dosing |
|---|---|
| Norepinephrine | Start 8–12 mcg/min; maintenance 2–4 mcg/min (as base). No labelled maximum. |
| Epinephrine | Septic shock: 0.05–2 mcg/kg/min; adjust every 10–15 min by 0.05–0.2. |
| Phenylephrine | Perioperative hypotension: 10–35 mcg/min or 0.5–1.4 mcg/kg/min; max 200 mcg/min. |
| Vasopressin | Septic shock 0.01–0.07 units/min (start 0.01, +0.005 every 10–15 min); post-cardiotomy 0.03–0.1 units/min. |
| Dopamine | Start 2–5 mcg/kg/min (5 if sicker); increase by 5–10 up to 20–50. |
| Dobutamine | Start 0.5–1 mcg/kg/min; usual 2–20; rarely up to 40. |
| Milrinone | Load 50 mcg/kg over 10 min; 0.375–0.75 mcg/kg/min; max 1.13 mg/kg/day. |
| Angiotensin II | Start 20 ng/kg/min; titrate up to every 5 min by ≤15; ≤80 in first 3 h; maintenance ≤40. |
Milrinone in renal impairment (label, by creatinine clearance in mL/min/1.73 m²): 50 → 0.43 · 40 → 0.38 · 30 → 0.33 · 20 → 0.28 · 10 → 0.23 · 5 → 0.20 mcg/kg/min.
Safety: peripheral lines, extravasation, pumps
- Peripheral start is acceptable. SSC 2026 (as in 2021) suggests starting vasopressors peripherally rather than delaying until central access. SSC 2021 remarks: use for a short period, in a vein in or proximal to the antecubital fossa; extravasation occurred in 3.4% in a systematic review, and 85% of reported events were from catheters distal to the antecubital fossa. Check the site often.
- Extravasation (catecholamines): stop the infusion. Labels for norepinephrine, epinephrine and dopamine: infiltrate the area as soon as possible with phentolamine 5–10 mg in 10–15 mL normal saline via a fine needle; effect is visible if given within 12 h.
- Angiotensin II: central line recommended; give VTE prophylaxis (thromboembolic events 13% vs 5% in ATHOS-3).
- Never stop abruptly — labels warn of marked hypotension; wean gradually.
- Pump library and double-check. Program from the smart-pump drug library, confirm concentration and dose unit (mcg/min vs mcg/kg/min) on the screen, and use an independent double-check for high-alert infusions per local policy.
- Norepinephrine salt. US labels express dose as base: 1 mg base = 1.89 mg bitartrate (anhydrous). Some countries label by salt — doses in the literature may not be interchangeable.
Sources
- Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Intensive Care Med 2026;52(5):863–936. doi:10.1007/s00134-026-08361-1 (also Crit Care Med 2026, doi:10.1097/CCM.0000000000007075)
- Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47:1181–247.
- Kotani Y, Di Gioia A, Landoni G, Belletti A, Khanna AK. An updated “norepinephrine equivalent” score in intensive care as a marker of shock severity. Crit Care 2023;27:29. doi:10.1186/s13054-023-04322-y (correction Crit Care 2025;29:104)
- Goradia S, Sardaneh AA, Narayan SW, Penm J, Patanwala AE. Vasopressor dose equivalence: a scoping review and suggested formula. J Crit Care 2021;61:233–40. doi:10.1016/j.jcrc.2020.11.002
- LEVOPHED (norepinephrine bitartrate) injection, prescribing information, Hospira 2025; Norepinephrine bitartrate in sodium chloride injection, prescribing information, WG Critical Care 2026 (DailyMed).
- ADRENALIN (epinephrine in sodium chloride) injection, prescribing information, Par 2026 (DailyMed).
- BIORPHEN (phenylephrine HCl) injection, prescribing information, 2026; Phenylephrine HCl in 0.9% sodium chloride 80 mcg/mL, prescribing information, Dr. Reddy's (DailyMed).
- VASOSTRICT (vasopressin) injection, prescribing information, Par 2026; Vasopressin in 0.9% sodium chloride, prescribing information, Baxter 2025 (DailyMed).
- Dopamine HCl and 5% dextrose; Dobutamine HCl in 5% dextrose; Milrinone lactate in 5% dextrose — prescribing information, Baxter 2026 (DailyMed).
- GIAPREZA (angiotensin II) injection, US prescribing information, La Jolla 2026 (DailyMed); EU SmPC (EMA).
Educational reference only — not a substitute for clinical judgment, institutional protocols, or specialist advice. Calculations run in your browser; nothing you enter is sent or stored.