• Produces vasoconstriction and myocardial stimulation, which may be required after adequate fluid replacement in the treatment of severe hypotension and shock.

Contraindicated in:

• Vascular, mesenteric, or peripheral thrombosis
• Hypoxia
• Hypercarbia
• Hypotension secondary to hypovolemia (without appropriate volume replacement)
• Hypersensitivity to bisulfites.

Use Cautiously in:

• Hypertension
• Concurrent use of MAO inhibitors, tricyclic antidepressants, or cyclopropane or halothane anesthetics
• Hyperthyroidism
• Cardiovascular disease
• OB: May ↓ uterine blood flow in pregnancy
• Lactation: Safety not established in breastfeeding.

CV: arrhythmia, bradycardia, chest pain, hypertension.

Endo: hyperglycemia.

F and E: metabolic acidosis.

GU: ↓urine output, renal failure.

Local: phlebitis at IV site.

Neuro: anxiety, dizziness, headache, insomnia, restlessness, tremor, weakness.

Resp: dyspnea.
Misc: fever.

Drug-Drug:

• Use with cyclopropane or halothane anesthesia, digoxin, doxapram, or local use of cocaine may result in ↑ myocardial irritability.
• Use with MAO inhibitors, doxapram, or tricyclic antidepressants may result in severe hypertension.
• Alpha-adrenergic blockers can prevent pressor response.
• Beta blockers may exaggerate hypertension or block cardiac stimulation.
• Concurrent use with ergot alkaloids (ergotamine, methylergonovine, or oxytocin) may result in enhanced vasoconstriction and hypertension.

(Generic available)

• Premixed infusion: 4 mg/250 mL D5W or 0.9% NaCl; 8 mg/250 mL D5W or 0.9% NaCl; 16 mg/250 mL 0.9% NaCl;
• Solution for injection: 1 mg/mL;

• IV (Adults): 0.5–1 mcg/min initially, followed by maintenance infusion of 2–12 mcg/min titrated by BP response (average rate 2–4 mcg/min, up to 30 mcg/min for refractory shock have been used).
• IV (Children): 0.1 mcg/kg/min initially; may be followed by infusion titrated to BP response, up to 1 mcg/kg/min.

Levophed

• Stimulates alpha-adrenergic receptors located mainly in blood vessels, causing constriction of both capacitance and resistance vessels.
• Also has minor beta-adrenergic activity (myocardial stimulation).

• Increased BP.
• Increased cardiac output.

Therapeutic Classification: vasopressors

Absorption: IV administration results in complete bioavailability.

Distribution: Concentrates in sympathetic nervous tissue. Does not cross the blood-brain barrier but readily crosses the placenta.

Metabolism/Excretion: Taken up and metabolized rapidly by sympathetic nerve endings.

Half-life: Unknown.

(effects on BP)

• Explain purpose of norepinephrine to patient.
• Instruct patient to report headache, dizziness, dyspnea, chest pain, or pain at infusion site promptly.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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