Norepinephrine
( Levarterenol ) Pronunciation: (NOR-eh-pih-NEFF-reen)Class: Vasopressor
Trade Names:
Levophed
- Injection 1 mg (as bitartrate)/mL
Pharmacology
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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.
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 StatesAdults
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 plasmaChemically incompatible with norepinephrine.
Furazolidone, guanethidine, MAO inhibitors, methyldopa, rauwolfia alkaloidsMay increase pressor response, resulting in severe hypertension.
Normal salineNorepinephrine may lose potency in normal saline solution.
Oxytocic drugsMay cause severe, persistent hypertension.
Phenothiazines (eg, chlorpromazine)May decrease pressor effect.
Tricyclic antidepressantsMay 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.
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