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norepinephrine

Pronunciation

Generic Name: norepinephrine (nor ep i NEF rin)
Brand Name: Levophed Bitartrate, Levophed

What is norepinephrine?

Norepinephrine is similar to adrenaline. It works by constricting (narrowing) the blood vessels and increasing blood pressure and blood glucose (sugar) levels.

Norepinephrine is used to treat life-threatening low blood pressure (hypotension) that can occur with certain medical conditions or surgical procedures. This medication is often used during CPR (cardio-pulmonary resuscitation).

Norepinephrine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about norepinephrine?

If possible before receiving norepinephrine, tell your doctor if you have high blood pressure, diabetes, coronary artery disease, circulation problems, varicose veins, overactive thyroid, asthma, or a sulfite allergy.

Also tell your doctor about all other medicines you use, especially blood pressure medication or an antidepressant.

In an emergency situation it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast feeding. Make sure any doctor caring for you afterward knows that you have received this medication.

Tell your caregivers at once if you have a serious side effect such as cold feeling anywhere in your body, blue lips or fingernails, trouble breathing, urinating less than usual, irritation or skin changes where the medicine is injected, slow heart rate, sudden numbness or weakness, confusion, severe headache, or problems with vision, speech, or balance.

What should I discuss with my health care provider before receiving norepinephrine?

If possible before you receive norepinephrine, tell your doctor if you have:

  • high blood pressure (hypertension);

  • diabetes;

  • coronary artery disease;

  • circulation problems;

  • varicose veins;

  • overactive thyroid; or

  • asthma or a sulfite allergy.

FDA pregnancy category C. It is not known whether norepinephrine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether norepinephrine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

In an emergency situation it may not be possible before you are treated with norepinephrine to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.

How is norepinephrine given?

Norepinephrine is injected into a vein through an IV. You will receive this injection in a hospital or emergency setting.

Norepinephrine is usually given for as long as needed until your body responds to the medication. Some people must receive norepinephrine for several days.

Your blood pressure, breathing, and other vital signs will be watched closely while you are receiving norepinephrine.

Tell your caregivers if you feel any pain, irritation, cold feeling, or other discomfort of your skin or veins where the medicine is injected. Norepinephrine can damage the skin or tissues around the injection site if the medication accidentally leaks out of the vein.

What happens if I miss a dose?

Since norepinephrine is given by a healthcare professional in an emergency setting, you are not likely to miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include slow heart rate or severe headache, sweating, vomiting, increased sensitivity to light, pale skin, and stabbing chest pain.

What should I avoid while receiving norepinephrine?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Norepinephrine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers at once if you have a serious side effect such as:

  • pain, burning, irritation, discoloration, or skin changes where the injection is given;

  • sudden numbness, weakness, or cold feeling anywhere in your body;

  • slow or uneven heart rate;

  • blue lips or fingernails, mottled skin;

  • urinating less than usual or not at all;

  • trouble breathing;

  • problems with vision, speech, or balance; or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

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

See also: Side effects (in more detail)

Norepinephrine Dosing Information

Usual Adult Dose for Hypotension:

Initial dose: 2 to 4 mcg/min
Maintenance dose: Adjust the rate for a low normal blood pressure (usually 80 to 100 mm Hg systolic). The average maintenance dose ranges from 1 to 12 mcg/min.

Usual Adult Dose for Shock:

Initial dose: 2 to 4 mcg/min
Maintenance dose: Adjust the rate for a low normal blood pressure (usually 80 to 100 mm Hg systolic). The average maintenance dose ranges from 1 to 12 mcg/min.

What other drugs will affect norepinephrine?

If possible before you receive norepinephrine, tell your doctor about all other medicines you use, especially:

  • blood pressure medications;

  • an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate); or

  • an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan, Silenor), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil).

This list is not complete and other drugs may interact with norepinephrine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about norepinephrine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.01. Revision Date: 2012-06-15, 12:23:09 AM.

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