Norepinephrine was recommended as the first vasopressor for septic shock resuscitation.
For the patient who did not response to high dose norepinephrine, epinephrine was
recommended.
Vasopressin was also recommended as an alternative vasopressor, in case patient did not
response to norepinephrine and or epinephrine.
Terlipressin, a selective V1 receptor binding with long half life, was reported that it main
action is to increase blood pressure via the different mechanism from norepinephrine and
epinephrine.
To use terlipressin, combine with norepinephrine and or epinephrine among refractory septic
shock, could decrease the usage dose of norepinephrine and epinephrine as well as lower the
side effects of too high adrenergic stimuli.