Norepinephrine

Norepinephrine is typically given as a continuous IV infusion in a hospital or emergency setting.

The starting dose is weight-based, and then the doctor will increase the dose to the desired response.

Norepinephrine Overdose

If you suspect an overdose, you should contact a poison control center or emergency room immediately.

You can get in touch with a poison control center at (800) 222-1222.

Missed Dose of Norepinephrine

You are unlikely to miss a dose of norepinephrine since it's given by a medical professional in an emergency setting.

Norepinephrine may be found in some form under the following brand names:

• Levophed Bitartrate

Serious side effects have been reported with norepinephrine.

Common side effects of norepinephrine include the following:

• headache
• a drop in heart rate
• arrhythmias (heart beat abnormalities)
• injury to tissues or organs due to a reduction of oxygen
• anxiety
• difficulty breathing

This is not a complete list of norepinephrine side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Usual Adult Dose for Hypotension:

Initial dose: 8 to 12 mcg/min continuous IV infusion
Maintenance dose: 2 to 4 mcg/min continuous IV infusion
Duration of therapy: Continue infusion until adequate blood pressure and tissue perfusion are maintained without therapy.

Comments:
-Doses given in terms of norepinephrine base.
-After observing response to initial dose, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 to 100 mmHg systolic) sufficient to maintain the circulation to vital organs.
-In previously hypertensive patients, blood pressure should be raised no higher than 40 mmHg below the preexisting systolic pressure.
-Doses should be titrated based on individual patient response.
-Infusions should be reduced gradually, avoiding abrupt withdrawal.

Uses: For blood pressure control in certain acute hypotensive cases (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions); and as an adjunct in the treatment of profound hypotension

Usual Adult Dose for Sepsis:

Society of Critical Care Medicine recommendations: 0.01 to 3 mcg/kg/min

Use: For use in patients during sepsis or septic shock to increase blood pressure

Usual Adult Dose for Cardiac Arrest:

Initial dose: 8 to 12 mcg/min continuous IV infusion
Maintenance dose: 2 to 4 mcg/min continuous IV infusion
Duration of therapy: Continue infusion until adequate blood pressure and tissue perfusion are maintained without therapy.

Comments:
-Doses given in terms of norepinephrine base.
-After observing response to initial dose, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 to 100 mmHg systolic) sufficient to maintain the circulation to vital organs.
-In previously hypertensive patients, blood pressure should be raised no higher than 40 mmHg below the preexisting systolic pressure.
-Doses should be titrated based on individual patient response.
-Infusions should be reduced gradually, avoiding abrupt withdrawal.

Use: As an adjunct in the treatment of cardiac arrest

American Heart Association recommendations: 0.1 to 0.5 mcg/kg/min IV infusion; titrate to effect

Comments:
-A 70 kg adult patient would receive a dose from 7 to 35 mcg/min.

Use: For use in the treatment of post cardiac arrest care for severe hypotension (e.g., systolic blood pressure less than 70 mmHg) and a low total peripheral resistance

For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions).

As an adjunct in the treatment of cardiac arrest and profound hypotension.

Norepinephrine Bitartrate Injection, USP, contains the equivalent of 4 mg base of Norepinephrine per each 4 mL ampule (1 mg/mL), and is available as follows:

NDC 36000-162-10 Ampules of 4 mL in shelf carton of 10

Store at 25°C (77°F); excursions permitted to 15 to 30°C (59 to 86°F) [see USP Controlled Room Temperature].
Retain in carton until time of use.
Protect from light.

Manufactured for:
Claris Lifesciences Inc.
North Brunswick, NJ 08902

by:
Sintetica S.A., Switzerland

67797 02

Issue: 11/2011

• Alpha/Beta Agonist

Note: Dose is stated in terms of norepinephrine base.

Hypotension/shock: Continuous IV infusion:

Initial: 8 to 12 mcg/minute; titrate to desired response. Usual maintenance range: 2 to 4 mcg/minute; dosage range varies greatly depending on clinical situation. If patient remains hypotensive despite large doses, evaluate for occult hypovolemia and provide fluid resuscitation as appropriate.

ACLS dosing range (weight-based dosing): Post cardiac arrest care: Initial: 0.1 to 0.5 mcg/kg/minute (7 to 35 mcg/minute in a 70 kg patient); titrate to desired response (AHA 2010)

Sepsis and septic shock (weight-based dosing): Range from clinical trials: 0.01 to 3 mcg/kg/minute (0.7 to 210 mcg/minute in a 70 kg patient) (Hollenberg 2004)

Concerns related to adverse effects:

• Extravasation: Vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation; infuse into a large vein if possible. Avoid infusion into leg veins. Monitor IV site closely. [US Boxed Warning]: If extravasation occurs, infiltrate the area with diluted phentolamine (5 to 10 mg in saline) with a fine hypodermic needle. Phentolamine should be administered as soon as possible after extravasation is noted to prevent sloughing /necrosis.

Disease-related concerns:

• Hypoxia/hypercarbia: Use in patients with profound hypoxia or hypercarbia may produce ventricular tachycardia or fibrillation; use with extreme caution.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Dosage form specific issues:

• Sodium metabisulfite: Product may contain sodium metabisulfite; use caution in patients with asthma or a sulfite allergy.

Other warnings/precautions:

• Administration: Administer infusions into a large vein, particularly an antecubital vein; some clinicians have indicated that the femoral vein is also an acceptable route. Avoid catheter tie-in technique, if possible. Avoid leg veins in elderly patients or in those suffering from occlusive disorders (eg, atherosclerosis, arteriosclerosis, diabetic endarteritis, Buerger disease). Gangrene has been reported in a lower extremity when infusions were given in an ankle vein.

• Appropriate use: Assure adequate circulatory volume to minimize need for vasoconstrictors. Avoid hypertension; monitor blood pressure closely and adjust infusion rate.

Initial dose: 8 to 12 mcg/min continuous IV infusion
Maintenance dose: 2 to 4 mcg/min continuous IV infusion
Duration of therapy: Continue infusion until adequate blood pressure and tissue perfusion are maintained without therapy.

Comments:
-Doses given in terms of norepinephrine base.
-After observing response to initial dose, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 to 100 mmHg systolic) sufficient to maintain the circulation to vital organs.
-In previously hypertensive patients, blood pressure should be raised no higher than 40 mmHg below the preexisting systolic pressure.
-Doses should be titrated based on individual patient response.
-Infusions should be reduced gradually, avoiding abrupt withdrawal.

Uses: For blood pressure control in certain acute hypotensive cases (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions); and as an adjunct in the treatment of cardiac arrest and profound hypotension

Data not available