Metaraminol

Alpha Agonist·Cardiovascular - Vasopressors & ICU

Acute hypotension (e.g., post-anaesthesia, epidural, or bridging to ICU)

VASOPRESSORAramineS4TGA

Max Dose

Variable

Half-life

10 mins

Bradycardia

REFLEX

Route

IV PERIPHERAL

Rapid Summary

Overview

Synthetic vasopressor. Acts as a safer, peripheral alternative to noradrenaline for bridging hypotension on the ward or in theatre.

Maximum Dose

Titrated to effect.

Clinical Focus

Highly prone to causing reflex bradycardia due to sudden spikes in blood pressure.

Bottom Line

Metaraminol is a rapid-acting vasopressor for acute intraoperative hypotension, but is a temporising measure only and must not replace definitive haemodynamic management.

Formulation & Access

Brand Names

Aramine

Parenteral

Ampoules (10 mg/1 mL). Often pre-drawn in 10 mL syringes (1 mg/mL).

Prescribing & PBS

Hospital supply only.

Indications & Use

Primary

TGA

Acute hypotension (e.g., post-anaesthesia, epidural, or bridging to ICU).

Clinical Place

The go-to 'ward' or 'theatre' vasopressor because it is significantly safer to run through a peripheral cannula than noradrenaline.

Quick reference

Class & Role

Alpha Agonist — Synthetic vasopressor.

Route / Formulation

Ampoules (10 mg/1 mL). Often pre-drawn in 10 mL syringes (1 mg/mL). (Aramine)

Usual Dose & Max

IV 0.5 - 1 mg push. Repeat as needed to achieve target BP. Titrated to effect.

Key Indication Doses

Hypotension (Bolus): IV 0.5 - 1 mg push. Repeat as needed to achieve target BP. Hypotension (Infusion): IV Infusion Start at 1-2 mg/hour. Titrate to MAP > 65.

Best Uses

Metaraminol is a rapid-acting vasopressor for acute intraoperative hypotension, but is a temporising measure only and must not replace definitive haemodynamic management.

Avoid / Cautions

Uncorrected hypovolemia, concurrent MAOI use. Pregnancy Category C.

Key Risks

Cardiovascular: Reflex bradycardia, ventricular arrhythmias, severe hypertension. Tissue: Extravasation necrosis (less severe than noradrenaline but still dangerous).

Key Interactions

MAOIs (e.g., phenelzine). Since metaraminol releases endogenous norepinephrine, MAOIs prevent its breakdown, causing lethal hypertensive crisis.

Monitoring

Continuous or frequent BP monitoring. Ensure the peripheral IV cannula is patent and flushes easily.

Clinical Pearl

When Metaraminol spikes the blood pressure, baroreceptors in the aortic arch trigger massive vagal tone, slowing the heart. Anticipate reflex bradycardia.

Access

Aramine

Brand: Aramine

Metaraminol

Alpha Agonist·Cardiovascular - Vasopressors & ICU

Acute hypotension (e.g., post-anaesthesia, epidural, or bridging to ICU)

VASOPRESSORAramineS4TGA

Max Dose

Variable

Half-life

10 mins

Bradycardia

REFLEX

Route

IV PERIPHERAL

Rapid Summary

Overview

Synthetic vasopressor. Acts as a safer, peripheral alternative to noradrenaline for bridging hypotension on the ward or in theatre.

Maximum Dose

Titrated to effect.

Clinical Focus

Highly prone to causing reflex bradycardia due to sudden spikes in blood pressure.

Bottom Line

Metaraminol is a rapid-acting vasopressor for acute intraoperative hypotension, but is a temporising measure only and must not replace definitive haemodynamic management.

Formulation & Access

Brand Names

Aramine

Parenteral

Ampoules (10 mg/1 mL). Often pre-drawn in 10 mL syringes (1 mg/mL).

Prescribing & PBS

Hospital supply only.

Indications & Use

Primary

TGA

Acute hypotension (e.g., post-anaesthesia, epidural, or bridging to ICU).

Clinical Place

The go-to 'ward' or 'theatre' vasopressor because it is significantly safer to run through a peripheral cannula than noradrenaline.

Quick reference

Class & Role

Alpha Agonist — Synthetic vasopressor.

Route / Formulation

Ampoules (10 mg/1 mL). Often pre-drawn in 10 mL syringes (1 mg/mL). (Aramine)

Usual Dose & Max

IV 0.5 - 1 mg push. Repeat as needed to achieve target BP. Titrated to effect.

Key Indication Doses

Hypotension (Bolus): IV 0.5 - 1 mg push. Repeat as needed to achieve target BP. Hypotension (Infusion): IV Infusion Start at 1-2 mg/hour. Titrate to MAP > 65.

Best Uses

Metaraminol is a rapid-acting vasopressor for acute intraoperative hypotension, but is a temporising measure only and must not replace definitive haemodynamic management.

Avoid / Cautions

Uncorrected hypovolemia, concurrent MAOI use. Pregnancy Category C.

Key Risks

Cardiovascular: Reflex bradycardia, ventricular arrhythmias, severe hypertension. Tissue: Extravasation necrosis (less severe than noradrenaline but still dangerous).

Key Interactions

MAOIs (e.g., phenelzine). Since metaraminol releases endogenous norepinephrine, MAOIs prevent its breakdown, causing lethal hypertensive crisis.

Monitoring

Continuous or frequent BP monitoring. Ensure the peripheral IV cannula is patent and flushes easily.

Clinical Pearl

When Metaraminol spikes the blood pressure, baroreceptors in the aortic arch trigger massive vagal tone, slowing the heart. Anticipate reflex bradycardia.

Access

Aramine

Brand: Aramine