Adult Dosing
Restoration of Blood Pressure in Acute Hypotensive States
- Initial: 0.5-1 mcg/min IV, followed by maintenance infusion of 2-12 mcg/min IV titrated by blood pressure response
Adjunctive Treatment in Cardiac Arrest
- Initial: 0.5-1 mcg/min IV, followed by maintenance infusion of 2-12 mcg/min IV titrated by blood pressure response
- Use average rate 2-4 mcg/min IV, up to 30 mcg/min IV for refractory shock
Supportive therapy in Pulmonary embolism [Non-FDA Approved]
- Initial dose 0.1-0.25 mcg/kg/min IV infusion, titrate every few minutes to desired response. Range of dosing typically required is 0.1-2 mcg/kg/min. Administered as an IV infusion, generally only through a central venous line
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Supportive therapy in Pulmonary embolism [Non-FDA Approved]
- Initial dose 0.1-0.25 mcg/kg/min IV infusion, titrate every few minutes to desired response. Range of dosing typically required is 0.1-2 mcg/kg/min. Administered as an IV infusion, generally only through a central venous line
Ricin poisoning [Non-FDA Approved]
- Starting dose:0.05 mcg/kg/min – 0.1 mcg/kg/min, with titration up to 2 mcg/kig/min if needed
Calcium Channel Blocker/Tricyclic Overdose [Non-FDA Approved]
- 0.05-0.1 mcg/kg/min IV infusion; titrate to effect; Maximum dose of 1-2 mcg/kg/min
[Outline]
- Immediately infiltrate the area in which extravasation has taken place with 10-15 mL of saline solution containing from 5-10 mg of phentolamine to prevent sloughing and necrosis; sympathetic blockade causes immediate conspicuous local hyperemic changes if area infiltrated within 12 hours [US Black Box Warning]
- Use with extreme caution in patients receiving monoamine oxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine types, because severe, prolonged hypertension may occur
- Therapy may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes
- Closely monitor blood pressure every two minutes from the time administration is started until the desired blood pressure is obtained, then every five minutes if administration is to be continued
- Constantly watch the rate of flow; patient should never be left unattended while receiving norepinephrine
- Administer therapy into a large vein, particularly an antecubital vein because it decreases the risk of necrosis of the overlying skin from prolonged vasoconstriction
- The infusion site should be checked frequently for free flow, care should be taken to avoid extravasation into the tissues
Cautions: Use cautiously in
- Hypersensitivity to sulfites
- MAO-inhibitor use
- Hyperthyroidism
Pregnancy Category:C
Breastfeeding: Safety unknown. No information is available on the use of norepinephrine during breastfeeding. High intravenous doses of norepinephrine might reduce milk production or milk letdown. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 26 April 2011). Manufacturer advises caution.
