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Norepinephrine( Levarterenol )
- Injection 1 mg (as bitartrate)/mL
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.
Norepinephrine is ineffective orally, subcutaneous absorption is poor, and IV absorption is immediate.
Norepinephrine is localized mainly in sympathetic nervous tissue and crosses the placenta.
Norepinephrine is excreted in urine (small amount eliminated as unchanged).
Onset of IV norepinephrine is rapid.
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.
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 AdministrationAcute Hypotensive States
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.
Store undiluted solution at controlled room temperature (59° to 86°F). Protect from light.
Drug InteractionsBlood 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.
Hypotension; increased peripheral vascular resistance; decreased carbon monoxide; precordial pain; ventricular arrhythmias; reflex bradycardia.
Headache; dizziness; tremor; insomnia; anxiety.
Metabolic acidosis; hyperglycemia.
Gangrene (when infused into small vein); thyroid enlargement; irritation from extravasation; decreased urinary output.
Category D .
Safety and efficacy not established.
Use caution in sulfite-sensitive individuals; some preparations contain sodium bisulfite.
Avoid by infusion into large vein and monitoring carefully.
Severe hypertension, reflex bradycardia, decreased cardiac output, increased peripheral vascular resistance, ventricular arrhythmias, tissue hypoxia and ischemic injury.
- 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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