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Norepinephrine

    Brands

    DEA Class;  Rx

    Common Brand Names; Levarterenol, Levophed

    • Alpha/Beta Adrenergic Agonists

    Intravenous catecholamine
    Used for restoration of blood pressure in patients with acute hypotensive states
    Potent alpha-adrenergic receptor agonist with modest beta-agonist activity

    Indicated for the treatment of acute hypotension, cardiogenic shock, sepsis, or septic shock.

    Hypersensitivity

    Patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed

    Peripheral vascular thrombosis (except for lifesaving procedures)

    Concomitant use with some general anesthetics cyclopropane (not available in the US), halothane (not available in the US)

    • Bradycardia
    • Hypertension
    • Arrhythmias
    • Confusion
    • Anxiety
    • Dyspnea, with or without respiratory difficulty
    • Headache
    • Nausea and vomiting
    • Sweating
    • Tremor
    • Restlessness
    • Urinary retention
    • Extravasation
    • Gangrene

    If therapy is continuously administered to maintain blood pressure in absence of blood volume replacement, severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis may occur

    Use extreme caution with concurrent monoamine oxidase inhibitor (MAOI) use or antidepressants of the triptyline or imipramine types; severe, prolonged hypertension may result

    Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and seem to sensitize the myocardium to action of intravenously administered epinephrine or norepinephrine

    Not for use in profound hypoxia or hypercarbia

    Bitartrate injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people

    Pregnancy category: C

    Lactation: Not known if excreted into breast milk; avoid use during breastfeeding

    Adults

    3.3 mcg/kg/minute continuous IV infusion has been used in refractory shock.

    Geriatric

    3.3 mcg/kg/minute continuous IV infusion has been used in refractory shock.

    Adolescents

    Safety and efficacy have not been established. Although dosage is titrated to effect, 2 mcg/kg/minute continuous IV infusion is often used as an upper limit.

    Children

    Safety and efficacy have not been established. Although dosage is titrated to effect, 2 mcg/kg/minute continuous IV infusion is often used as an upper limit.

    Infants

    Safety and efficacy have not been established. Although dosage is titrated to effect, 2 mcg/kg/minute continuous IV infusion is often used as an upper limit.

    Neonates

    Safety and efficacy have not been established. Although dosage is titrated to effect, 2 mcg/kg/minute continuous IV infusion is often used as an upper limit.

    Norepinephrine bitartrate 

    injectable solution

    • 1mg/mL