Metaraminol Uses, Dosage, Side Effects & Warnings | DrugsAtlas

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DRUG NAME: Metaraminol

Therapeutic Class: Vasopressor
Subclass: Alpha-adrenergic agonist
Speciality: Anaesthesiology

Schedule (India): Schedule H
Route(s): Intravenous (IV)
Formulations Available in India:
• Injection: 10 mg/mL in 1 mL ampoule (as metaraminol bitartrate)

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

▶ Treatment of Hypotension during Anaesthesia

Parameter	Recommendation
Starting dose	0.5–2.5 mg IV bolus
Titration	Repeat bolus every 2–5 minutes as needed; single bolus not to exceed 5 mg
Usual maintenance dose	Continuous IV infusion at 0.5–5 mg/hour, titrated to blood pressure response
Maximum dose	Not formally defined; guided by blood pressure control and adverse effect profile

Clinical Notes:
• Dilute prior to infusion: typically 10 mg in 500 mL of 5% dextrose or 0.9% sodium chloride
• Central venous access preferred for prolonged infusion
• Ensure adequate volume resuscitation before initiating vasopressor therapy
• Use with caution in patients with pre-existing cardiac disease or uncorrected hypovolaemia

Secondary Indications — Adults (Off-label, if any)

▶ Vasopressor Support in Septic Shock (as adjunct to norepinephrine) — OFF-LABEL

Parameter	Recommendation
Starting dose	2–5 mg IV bolus
Titration	Follow with infusion at 0.5–5 mg/hour, titrated to target MAP
Usual maintenance dose	Based on haemodynamic response
Maximum dose	Titrate to effect; no defined upper limit
Duration	Short-term use during vasodilatory shock

• Specialist only
• Evidence basis: Limited observational data; extrapolated from anaesthesia protocols; not first-line agent for septic shock

PAEDIATRIC DOSING (Specialist Only)

Primary Indication

▶ Intraoperative Hypotension — OFF-LABEL USE

Parameter	Recommendation
Starting dose (IV bolus)	10–20 mcg/kg
Titration	May repeat every 5–10 minutes based on blood pressure
Usual maintenance dose (infusion)	Start at 1 mcg/kg/min; titrate to response
Maximum dose	Up to 5 mcg/kg/min
Minimum age	Use only under paediatric anaesthetist guidance; no established lower age limit

Safety Monitoring:
• Confirm adequate intravascular volume prior to use
• Continuous blood pressure and heart rate monitoring mandatory
• Central line access preferred for infusion

Secondary Indications — Paediatric Doses (Off-label, if any)

• No well-established off-label indications in paediatric practice beyond anaesthesia settings in India
• Use restricted to operating theatre or paediatric intensive care under specialist supervision

RENAL ADJUSTMENT

Renal Function	Recommendation
Mild to moderate impairment	No dose adjustment required
Severe impairment	Use with caution; potential for prolonged drug clearance

Monitoring: Blood pressure and urine output should be closely monitored

HEPATIC ADJUSTMENT

Severity	Recommendation
Mild impairment	No specific adjustment; monitor blood pressure and perfusion
Moderate impairment	No specific adjustment; monitor closely
Severe impairment	Use with caution; titrate slowly; no specific hepatotoxicity documented

CONTRAINDICATIONS

• Known hypersensitivity to metaraminol or any formulation excipient
• Phaeochromocytoma
• Mesenteric or peripheral vascular thrombosis (risk of worsening ischaemia from vasoconstriction)
• Concurrent use of monoamine oxidase inhibitors (MAOIs) — risk of hypertensive crisis

CAUTIONS

• Ischaemic heart disease, arrhythmias, or cardiomyopathy
• Uncorrected hypovolaemia — volume resuscitation must precede vasopressor use
• Elderly or frail patients — heightened risk of excessive hypertensive response
• Extravasation risk — may cause tissue necrosis; avoid peripheral infusion for prolonged use
• Use only under continuous blood pressure monitoring

PREGNANCY

Consideration	Recommendation
Overall safety	Use with caution — limited human data available
When it may be used	May be considered for hypotension during spinal or epidural anaesthesia if benefit outweighs risk
Risk	Potential uterine vasoconstriction; may affect uteroplacental perfusion
Preferred alternatives	Phenylephrine is commonly used in obstetric anaesthesia; consult specialist
Monitoring	Uteroplacental perfusion, fetal heart rate if used antenatally

• Specialist use only

LACTATION

Consideration	Recommendation
Compatibility	Not well studied; compatibility with breastfeeding uncertain
Drug levels in milk	Likely present in low amounts; minimal oral bioavailability expected in infant
Preferred alternatives	Consider alternatives where possible
Infant monitoring	Feeding difficulty, irritability, behavioural changes

ELDERLY

Consideration	Recommendation
Starting dose	Use lower end of bolus range (e.g., 0.5–1 mg IV)
Titration	Slower titration preferred
Risks	Increased susceptibility to hypertensive response, reflex bradycardia, arrhythmias
Monitoring	Cardiac status, renal perfusion, blood pressure continuously

MAJOR DRUG INTERACTIONS

Interacting Drug	Effect / Mechanism	Recommendation
Monoamine oxidase inhibitors (MAOIs)	Hypertensive crisis risk due to inhibited catecholamine breakdown	Avoid combination
Tricyclic antidepressants	Potentiation of vasopressor effects	Avoid or monitor closely
Halothane	Risk of ventricular arrhythmias (sensitises myocardium to catecholamines)	Use with extreme caution during anaesthesia
Ergot alkaloids	Additive vasoconstriction; risk of severe peripheral ischaemia	Avoid combination

MODERATE DRUG INTERACTIONS

Interacting Drug	Effect / Mechanism	Recommendation
Beta-blockers	May enhance reflex bradycardia	Monitor heart rate
Diuretics	Hypovolaemia may blunt pressor response	Correct volume status before use
Corticosteroids	May enhance pressor response	Adjust dose if combined
Other vasopressors (e.g., norepinephrine, phenylephrine)	Additive haemodynamic effects	Titrate cautiously

COMMON ADVERSE EFFECTS

• Hypertension
• Reflex bradycardia
• Headache
• Palpitations
• Nausea

SERIOUS ADVERSE EFFECTS

Adverse Effect	Clinical Note
Ventricular arrhythmias	Risk increased with halogenated anaesthetics
Extravasation injury	Causes local tissue necrosis; requires immediate treatment with phentolamine infiltration
Myocardial ischaemia	Monitor for chest pain in at-risk patients
Peripheral or mesenteric ischaemia	Due to excessive vasoconstriction
Pulmonary oedema	Rare

MONITORING REQUIREMENTS

Phase	Parameters
Baseline	Blood pressure, ECG, volume status assessment
During treatment	Continuous BP and ECG monitoring, heart rate, urine output
Infusion site	Monitor for extravasation; use central line for prolonged infusion
Signs of ischaemia	Chest pain, peripheral pulses, signs of organ hypoperfusion

BRANDS AVAILABLE IN INDIA

• Aramine Injection (Abbott)
• Metaramin Injection (Neon Laboratories)

Note: Availability may vary by region and institutional procurement

PRICE RANGE (INR)

• Approximately ₹120–₹200 per 1 mL ampoule (10 mg/mL)
• Not under NPPA price control
• Prices may differ between institutional procurement and retail pharmacies

CLINICAL PEARLS

• Reserve metaraminol as second-line vasopressor in shock; norepinephrine remains first-line in septic shock
• Ideal agent for managing hypotension during regional anaesthesia or anaesthesia-induced vasodilation
• Never initiate without prior volume resuscitation — may worsen organ perfusion in hypovolaemia
• Always dilute before IV infusion; prefer central venous access for prolonged administration
• Reflex bradycardia is common — reduce dose or discontinue if excessive
• Extravasation requires prompt treatment with local phentolamine infiltration to prevent tissue necrosis

VERSION

RxIndia v1.1 — 18 Feb 2026

REFERENCES

• CDSCO
• Indian Pharmacopoeia (IP)
• National Formulary of India (NFI)
• AIIMS Anaesthesia Protocols
• Goodman & Gilman’s The Pharmacological Basis of Therapeutics
• API Textbook of Medicine
• Indian tertiary care hospital protocols

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Clinical Responsibility

This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

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