Slideshows Images Quizzes

Norepinephrine

Medical and Pharmacy Editor:

Brand Name: Levarterenol, Levophed

Generic Name: Norepinephrine

Drug Class: Alpha/Beta Adrenergic Agonists

What Is Norepinephrine Used For?

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

Norepinephrine is also indicated as an adjunct in the treatment of cardiac arrest and profound hypotension.

Norepinephrine is available under the following different brand names: Levarterenol, and Levophed.

Dosages of Norepinephrine

Adult and Pediatric Dosage Forms and Strengths

Injectable solution

Dosage Considerations – Should be Given as Follows:

Acute Hypotension

Adult

  • Initial: 8-12 mcg/minute intravenous (IV) infusion; titrate to effect
  • Maintenance: 2-4 mcg/minute IV infusion

Pediatric

  • Initial: 0.05-0.1 mcg/kg/minute intravenous (IV) infusion; titrate to effect
  • Maximum: 1-2 mcg/kg/minute

Cardiac Arrest

Adult

  • Initial: 8-12 mcg/minute intravenous (IV) infusion; titrate to effect
  • Maintenance: 2-4 mcg/minute IV infusion

Pediatric

  • Initial: 0.05-0.1 mcg/kg/minute intravenous (IV) infusion; titrate to effect
  • Maximum: 1-2 mcg/kg/minute

Sepsis and Septic Shock

  • Adult: 0.01-3 mcg/kg/minute intravenous (IV) infusion
  • Pediatric: 0.05-0.1 mcg/kg/minute IV infusion; titrate to effect; not to exceed 2 mcg/kg/minute

Beta Blocker Toxicity (Off-label)

  • Should be titrated to age-appropriate blood pressure

Calcium Channel Blocker Toxicity (Off-label)

  • Should be titrated to age-appropriate blood pressure

Tricyclic Antidepressant Toxicity (Off-label)

  • Should be titrated to age-appropriate blood pressure
Low Blood Pressure (Hypotension):How Low is Too Low?

What Are Side Effects Associated with Using Norepinephrine?

Common side effects of norepinephrine include:

Serious side effects of norepinephrine include:

This is not a complete list of side effects and other serious side effects may occur. Call your doctor for information and medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What Other Drugs Interact with Norepinephrine?

If your doctor has directed you to use this medication for your condition, your doctor or pharmacist may already be aware of any possible drug interactions or side effects and may be monitoring you for them. Do not start, stop, or change the dosage of this medicine or any medicine before getting further information from your doctor, healthcare provider or pharmacist first.

Severe interactions of norepinephrine include:

Norepinephrine has serious interactions with at least 34 different drugs.

Norepinephrine has moderate interactions with at least 261 different drugs.

Mild Interactions of norepinephrine include:

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Low Blood Pressure (Hypotension):How Low is Too Low?

What Are Warnings and Precautions for Norepinephrine?

Warnings

AAntidote for extravasation ischemia: To prevent sloughing and necrosis in areas where extravasation has taken place, infiltrate areas promptly with 10-15 mL of saline solution containing 5-10 mg of phentolamine mesylate for injection.

Use syringe with fine hypodermic needle, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, pallid appearance.

This medication contains norepinephrine. Do not take Levarterenol or Levophed if you are allergic to norepinephrine or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Effects of Drug Abuse

No information available

Short-Term Effects

  • See "What Are Side Effects Associated with Using Norepinephrine?"

Long-Term Effects

  • See "What Are Side Effects Associated with Using Norepinephrine?"

Cautions

  • Mesenteric or peripheral vascular thrombosis.
  • Avoid infusion site extravasation.
  • Not for use in profound hypoxia.
  • Sulfite allergy due to presence of metabisulfite.
  • Monitor blood pressure.
  • Extreme caution in concurrent monoamine oxidase inhibitor (MAOI) use.

Pregnancy and Lactation

  • Use norepinephrine with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
  • It is not known if norepinephrine is excreted into breast milk; avoid use during breastfeeding.
Reviewed on 1/26/2018

References:
Medscape. Norepinephrine.
https://reference.medscape.com/drug/levarterenol-levophed-norepinephrine-342443
DailyMed. Norepinephrine Bitartrate
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a27fb6e0-8f7a-11db-9739-0050c2490048
RxList. Levophed.
https://www.rxlist.com/levophed-side-effects-drug-center.htm

Health Solutions From Our Sponsors