Norepinephrine

Other Cardiovascular Preps · Vasoconstrictor sympathomimetic

Indications

Acute hypotension. Cardiac arrest.

Dosage

Acute hypotension: Adults: By intravenous infusion, via central venous catheter, of a solution containing noradrenaline acid tartrate 80 mcg/ mL (equivalent to noradrenaline base 40 mcg/ mL) at an initial rate of 0.16-0.33 mL/min, adjusted according to response. Cardiac arrest: Adults: By rapid intravenous or intracardiac injection, 0.5-0.75 mL of a solution containing noradrenaline acid tartrate 200 mcg/ mL (equivalent to noradrenaline base 100 mcg/ mL).

Administration

By IV infusion into a large vein. A 4 mcg/mL dilution of norepinephrine base for infusion is usually prepared by adding 4 mg of base (4 mL) to 1000 mL of D5W with or without NS. Reconstitution: Dilute with D5W or D5NS, but not recommended to dilute in NS. Stable for 24 hours at room temp. Compatibility: Stable in D5NS, D5W, LR. Avoid contact with iron salts, alkalis, or oxidizing agents. Administer whole blood or plasma separately (i.e. by use of a Y-tube and individual containers if given simultaneously). Y-site administration: Drug to Drug IV Compatibility: Amikacin, amiodarone, aztreonam, bumetanide, calcium gluconate, cephazolin, ceftriaxone, ciprofloxacin, cisatracurium, dexamethasone, diltiazem, diphenhydramine, dobutamine, dopamine, enalapril, epinephrine, esmolol, famotidine, fentanyl, fluconazole, gentamicin, heparin, hydrocortisone, hydromorphone, imipenem, labetalol,…

Adverse Effects

Hypertension, headache, bradycardia, arrhythmias, peripheral ischaemia.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Caution advised or effect undetermined. Contraindications: Hypertension (monitor blood pressure and rate of flow frequently). Precautions: Coronary, mesenteric, or peripheral vascular thrombosis following myocardial infarction. Prinzmetal's variant angina, hyperthyroidism, diabetes mellitus, hypoxia or hypercapnia, uncorrected hypovolaemia, elderly. Extravasation at injection site may cause necrosis.

Interactions

Beta-blockers, cyclopropane and halothane anaesthetics, COMT inhibitors, MAOIs or TCAs.

Advice to Patient

Immediately report burning, leaking or tingling around IV site. Contact prescriber/caregivers if there is cold feeling in body, difficulty in breathing, blue lips or fingernails, less urination, skin changes/irritation at the treated area, numbness, weakness, confusion, severe headache, slow heart rate, difficulty in vision/speaking/balance.

Pharmacokinetics

Onset of action: Very rapid acting. Duration: Vasopressor: 1-2 min. Metabolism: Via COMT and MAO Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.