NOR-ep-i-nef-rin
Absorption: IV administration results in complete bioavailability.
Distribution: Concentrates in sympathetic nervous tissue. Does not cross the blood-brain barrier.
Half-Life: 2.5 min.
Contraindicated in:
Use Cautiously in:
CV: arrhythmia, bradycardia, chest pain, hypertension
Endo: hyperglycemia
F and E: metabolic acidosis
GU: ↓urine output, renal failure
Local: phlebitis
Neuro: anxiety, dizziness, headache, insomnia, restlessness, tremor, weakness
Resp: dyspnea
Misc: fever
Drug-drug:
Toxicity and Overdose:
IV Administration:
Norepinephrine is a vesicant. Central line administration is preferred; extravasation may cause severe ischemic necrosis. If central line is not available, may administer for <72 hr through a peripheral IV catheter placed in a large vein at a proximal site (e.g., in or proximal to antecubital fossa). May also administer through a midline catheter. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry warm compresses. Initiate phentolamine antidote for refractory cases in addition to supportive management. For phentolamine, dilute 5–10 mg in 10 mL of 0.9% NaCl and administer SUBQ into extravasation site as soon as possible after extravasation; if IV catheter remains in place, administer initial dose IV through the infiltrated catheter. May repeat in 60 min if patient remains symptomatic. Nitroglycerin 2% topical ointment (1-inch strip applied to site of ischemia to cover affected area; may repeat every 8 hr as necessary) or terbutaline may be used as alternatives to phentolamine. For terbutaline, for large areas of extravasation, dilute 1 mg in 10 mL of 0.9% NaCl and administer SUBQ into extravasation site; may repeat in 15 min if necessary; for small areas of extravasation, dilute 1 mg in 1 mL of 0.9% NaCl and administer 0.5 mg (0.5 mL) SUBQ into extravasation site; may repeat in 15 min if necessary.