Norepinephrine

FDA label

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Titration After initial dose, assess response and adjust; monitor BP every 2 minutes until desired hemodynamic effect achieved, then every 5 minutes for duration of infusion.

Renal Undefined

Hepatic Undefined

Instructions

• Correct hypovolemia before initiating; suspect occult hypovolemia if no response
• Dilute before use: 4 mg in 1,000 mL D5W or dextrose-5%-containing saline (4 mcg/mL); saline alone not recommended; use higher concentrations if fluid-restricted
• Infuse into a large vein; avoid leg veins in elderly or occlusive vascular disease; avoid catheter tie-in technique
• On discontinuation, reduce flow rate gradually — avoid abrupt withdrawal (marked hypotension); expand blood volume with IV fluids
• Extravasation: infiltrate area ASAP with phentolamine 5–10 mg in 10–15 mL 0.9% NaCl via fine needle (effective within 12 h)
• Do not use if pinkish, darker than slightly yellow, or precipitated; diluted solution usable up to 24 h at room temp, protect from light
• Avoid contact with iron salts, alkalis, oxidizing agents; give whole blood/plasma separately
• Elderly: start at low end of dosing range

Available strengths

• inj 1 mg/mL

Cautions

• Tissue ischemia: extravasation can cause necrosis/sloughing; severe vasoconstriction if given during uncorrected hypovolemia; avoid in mesenteric or peripheral vascular thrombosis; gangrene of extremities reported with occlusive/thrombotic vascular disease or prolonged/high-dose infusion
• Marked hypotension after abrupt discontinuation — taper infusion rate
• Cardiac arrhythmias (especially with hypoxia/hypercarbia); continuous cardiac monitoring in patients with arrhythmias/underlying heart disease
• Contains sodium metabisulfite — allergic-type reactions including anaphylaxis, more frequent in asthmatics

Adverse reactions

• Hypertension, bradycardia (most common)
• Ischemic injury; extravasation necrosis at injection site
• Anxiety, transient headache
• Respiratory difficulty, pulmonary edema

Pregnancy Limited human data (use at delivery) show no increased risk of birth defects/miscarriage; untreated shock is a medical emergency — do not withhold life-sustaining therapy; high-dose animal data show reduced placental blood flow.

Lactation No data; clinically relevant infant exposure not expected (short half-life, poor oral bioavailability).