norepinephrine

Contraindicated in:

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

Use Cautiously in:

Hypertension;
Hyperthyroidism;
Cardiovascular disease;
OB: May ↓ uterine blood flow in pregnancy;
Lactation: Safety not established in breastfeeding.

Adv. Reactions/Side Effects ⬆ ⬇

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

Interactions ⬆ ⬇

Drug-drug:

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

Availability ⬆ ⬇

(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

Route/Dosage ⬆ ⬇

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

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).

Therapeutic effects:

Increased BP.
Increased cardiac output.

Classifications ⬆ ⬇

Therapeutic Classification: vasopressors

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

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

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

Half-Life: 2.5 min.

Time/Action Profile ⬆ ⬇

( effects on BP)

ROUTE		ONSET		PEAK		DURATION
IV		immediate		rapid		1–2 min

Patient/Family Teaching ⬆ ⬇

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

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

43742- Deseret Biologicals, Inc.
- 43742-1489- Norepinephrine
  - 43742-1489-1- 30 mL in 1 BOTTLE, DROPPER (43742-1489-1)

43857- BioActive Nutritional, Inc.
- 43857-0161- Norepinephrine
  - 43857-0161-1- 30 mL in 1 BOTTLE, DROPPER (43857-0161-1)

43857- BioActive Nutritional, Inc.
- 43857-0260- Norepinephrine
  - 43857-0260-1- 30 mL in 1 BOTTLE, DROPPER (43857-0260-1)

44911- Energique, Inc.
- 44911-0499- Norepinephrine Phenolic
  - 44911-0499-1- 30 mL in 1 BOTTLE, DROPPER (44911-0499-1)

44911- Energique, Inc.
- 44911-0669- Norepinephrine Phenolic
  - 44911-0669-1- 60 mL in 1 BOTTLE, DROPPER (44911-0669-1)

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Indications ⬇

Contraind./Precautions ⬆ ⬇