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Norepinephrine

Pronunciation
( Levarterenol )

Pronunciation: NOR-eh-pih-NEFF-reen
Class: Vasopressor

Trade Names

Levophed
- Injection 1 mg (as bitartrate)/mL

Pharmacology

Stimulates alpha-receptors in arterial and venous beds and beta 1 receptors of heart, resulting in peripheral vasoconstriction and stimulation of heart rate and contractility. Coronary vasodilation occurs secondary to enhanced myocardial contractility.

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Pharmacokinetics

Absorption

Norepinephrine is ineffective orally, subcutaneous absorption is poor, and IV absorption is immediate.

Distribution

Norepinephrine is localized mainly in sympathetic nervous tissue and crosses the placenta.

Elimination

Norepinephrine is excreted in urine (small amount eliminated as unchanged).

Onset

Onset of IV norepinephrine is rapid.

Duration

Duration of norepinephrine is 1 to 2 min (discontinuation of IV).

Indications and Usage

Restoration of BP in certain acute hypotensive states; adjunct in treatment of cardiac arrest and profound hypotension.

Contraindications

Hypovolemic states, except temporarily until blood volume replacement is accomplished; mesenteric or peripheral vascular thrombosis, unless essential; generally contraindicated during cyclopropane and halothane anesthesia; profound hypoxia or hypercarbia.

Dosage and Administration

Acute Hypotensive States
Adults

IV 2 to 3 mL/min of 4 mcg base/mL solution (8 to 12 mcg/min); adjust to response. Higher concentration (up to 16 mcg/mL) may be used in fluid-restricted patients. Usual maintenance dose is 2 to 4 mcg/min, but higher doses and prolonged therapy may be needed.

Storage/Stability

Store undiluted solution at controlled room temperature (59° to 86°F). Protect from light.

Drug Interactions

Blood or plasma

Chemically incompatible with norepinephrine.

Furazolidone, guanethidine, MAO inhibitors, methyldopa, rauwolfia alkaloids

May increase pressor response, resulting in severe hypertension.

Normal saline

Norepinephrine may lose potency in normal saline solution.

Oxytocic drugs

May cause severe, persistent hypertension.

Phenothiazines (eg, chlorpromazine)

May decrease pressor effect.

Tricyclic antidepressants

May increase pressor response.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Hypotension; increased peripheral vascular resistance; decreased carbon monoxide; precordial pain; ventricular arrhythmias; reflex bradycardia.

CNS

Headache; dizziness; tremor; insomnia; anxiety.

Metabolic

Metabolic acidosis; hyperglycemia.

Respiratory

Respiratory difficulties.

Miscellaneous

Gangrene (when infused into small vein); thyroid enlargement; irritation from extravasation; decreased urinary output.

Precautions

Pregnancy

Category D .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Sulfite Sensitivity

Use caution in sulfite-sensitive individuals; some preparations contain sodium bisulfite.

Extravasation

Avoid by infusion into large vein and monitoring carefully.

Overdosage

Symptoms

Severe hypertension, reflex bradycardia, decreased cardiac output, increased peripheral vascular resistance, ventricular arrhythmias, tissue hypoxia and ischemic injury.

Patient Information

  • Advise patient to notify nurse if IV site feels cool or painful.
  • Instruct patient to report the following symptoms to health care provider: dizziness, nausea, syncope, abdominal pain, chest pain or confusion.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension.

Copyright © 2009 Wolters Kluwer Health.

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