Metaraminol in critical care and anesthesia: A safe alternative for hypotension management?

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.