Metaraminol is a small molecule drug approved for treating hypotension (low blood pressure)

due to causes such as hemorrhage, spinal anesthesia, and shock associated with brain
damage. It acts as a potent sympathomimetic amine that increases systolic and diastolic
blood pressure by acting as a pure alpha-1 adrenergic receptor agonist, leading to
peripheral vasoconstriction and increasing systemic blood pressure. It also indirectly releases
norepinephrine from storage sites. Metaraminol has an onset of action of 1-2 minutes after IV
injection, 10 minutes after IM injection, and 5-20 minutes after subcutaneous injection. The drug
has an average molecular weight of 167.205, and its chemical formula is C9H13NO2. The most
common adverse effects of metaraminol include increased blood pressure, tachycardia, and
headache. Its use is contraindicated in specific populations and may interact with other drugs.

Use of Metarminol In the Emergency department for shock in comparison to Noradrenaline

The first study, Natalini et al (2005) was a prospective cohort study conducted in Italy with 10
patients with septic shock, and it compared the use of norepinephrine and metaraminol. The
results showed no significant difference in cardiac output, stroke volume index, heart rate,
haemodynamic variables, drug doses, or patient acid-base status between the two drugs. The
second study, Hou et al (2007), was a retrospective cohort study conducted in China with 98
patients with septic shock, and it evaluated the impact of different infusion rates of metaraminol
on renal function parameters. The results showed no significant differences in the changes of
these parameters among the three groups with different infusion rates. The third study,
Makowski and Misztal (2010), was a prospective observational study conducted in the UK with
47 patients in a surgical high-dependency unit who were started on peripheral metaraminol
infusion. The results showed a decrease in fluid balance after metaraminol infusion, but no
information was available on the reason for starting metaraminol in the patients.

The clinical bottom line is that despite anecdotal evidence of common usage, there is
limited high-quality evidence to support the use of peripheral metaraminol as
vasopressor support in the emergency department.

Use of Metarminol in Priapism

A case report published in the lancet talks about a 50-year-old patient with chronic myeloid
leukemia (CML) in blast crisis who was treated for priapism, a rare but recognized complication
of CML. The patient had a painful erection that did not respond to conventional treatment
methods. The authors decided to try metaraminol, which Professor Brindley had successfully
used to reverse experimental priapism caused by the alpha blockade. 1 mg of metaraminol was
injected into each corpus cavernosum 8 hours after the onset of the erection, and 15-20 ml of
blood was withdrawn. The injection resulted in improvement, but the erection remained. Another
injection of 1 mg metaraminol was made into each corpus cavernosum an hour later, which
resulted in complete detumescence and relief of the erection within half an hour without any
systemic effects. The authors concluded that metaraminol was a successful and less
traumatic approach to treating priapism, particularly in cases associated with malignant
disease.
References

1 Natalini G, Schivalocchi V, Rosano A, et al. Norepinephrine and metaraminol in septic shock:

a comparison of the hemodynamic effects. Intensive Care Med 2005;31:634–7.
2 Hou LC, Li SZ, Xiong LZ, et al. Effect of dopamine and metaraminol on the renal function of
patients with septic shock. Chin Med J 2007;120:680–3.
3 Makowski A, Misztal B. Metaraminol peripheral infusion for the treatment of hypotension on
surgical high dependency unit (SHDU) may reduce the need for excessive fluid administration in
the post-operative population. Intensive Care Med 2010;36:0342–4642.
4. Stanners A, Colin-Jones D. Metaraminol for priapism. Lancet. 1984 Oct
27;2(8409):978. doi: 10.1016/s0140-6736(84)91187-5. PMID: 6149362.