Levophed has always been the drug of choice in the right situations from my personal experience.
I'm not sure where that silly rhyme started, but I suspect some smart resident (an oxymoron?)after making some poor decisions decided to blame a medication.
I have worked in CVICU's for almost 15 yrs. and can't imagine not using Levophed when needed.
I believe it got its undeserved reputation from practitioners using it improperly. You MUST ensure your pt.'s hypotension is not the result of hypovolemia. Trying to clamp down on a dry pt. is a recipe for disaster. Preferably you will have a Swan-Ganz catheter but a simple CVP reading via a central line will do in a pinch, and obviously you must have an arterial line to monitor your BP.
If your SVR is 400 and you've dumped fluid in with no increase in BP,Levophed is gonna help that pt. quicker and without the tachycardia Dopamine and Epi bring to the table. Vasopressin? Puleeze, if your pt. is in trouble don't waste time.
Use Levophed, it's a great drug, and monitor your pt.
closely and the only thing left dead will be that old nursing wives tale.