Norepinephrine

Uses

For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions). As an adjunct in the treatment of cardiac arrest and profound hypotension.

Norepinephrine is also used to associated treatment for these conditions: Hypotension, Neurogenic shock, Septic Shock, Serum Sickness

How Norepinephrine works

Norepinephrine functions as a peripheral vasoconstrictor by acting on alpha-adrenergic receptors. It is also an inotropic stimulator of the heart and dilator of coronary arteries as a result of it's activity at the beta-adrenergic receptors.

Dosage

Norepinephrine dosage

Upper gastrointestinal haemorrhage:

• Adult: Intraperitoneal admin: 8 mg in 250 ml of 0.9% sodium chloride inj. Alternatively, instill 8 mg in 100 ml of 0.9% sodium chloride solution through a nasogastric tube every hr for 6–8 hr, then every 2 hr for 4–6 hr. Withdraw drug gradually.

Acute hypotensive states:

• Adult: Initially, 8-12 mcg/minute, up to 8-30 mcg/minute in refractory shock. Infuse using a solution of 4 mcg/ml in glucose 5%, or sodium chloride 0.9% and glucose 5% at a rate of 2-3 ml/minute. Adjust according to BP response. Average maintenance dose: 0.5-1 ml/minute (2-4 mcg/minute). Infuse via a central venous catheter or into a large vein.
• Child: Administer at a rate of 2 mcg/minute. Alternatively, 2 mcg/m2/minute. Adjust rate according to BP response and perfusion.
• Elderly: Initial dose should be at low end of dose range.

Intravenous: Dilute with 5% glucose inj, with or without sodium chloride; dilution with sodium chloride inj alone is not recommended.

Side Effects

Hypertension, headache, peripheral ischaemia, bradycardia, arrhythmias, anxiety, skin necrosis (with extravasation), dyspnoea, respiratory difficulty.

Toxicity

In high dose and especially when it is combined with other vasopressors, it can lead to limb ischemia and limb death.

Precaution

Not a substitute for replacement of blood, plasma, fluids, and/or electrolytes; correct volume depletion prior to admin. Identify and correct hypoxia, hypercapnia and acidosis prior to or during admin. Avoid extravasation as tissue necrosis may occur. Avoid inj into leg veins, especially in elderly or those with occlusive vascular diseases, arteriosclerosis, DM or Buerger's disease. Hypertensive or hyperthyroid patients. In conjunction with local anaesthetics, do not use in fingers, toes, ears, nose or genitalia. Lactation.

Interaction

Guanethidine, methyldopa, reserpine, TCAs may increase pressor response to norepinephrine.

Food Interaction

Norepinephrine Drug Interaction

Moderate: albuterol / ipratropium, levothyroxine, metoprololUnknown: aspirin, epinephrine, ipratropium, ciprofloxacin, glucose, lvp solution, heparin, lvp solution, furosemide, sodium chloride, acetaminophen, dexmedetomidine, valproic acid, midazolam, cyanocobalamin, ascorbic acid, phytonadione

Norepinephrine Disease Interaction

Major: peripheral vascular thrombosis, dehydrationModerate: acidosis

Pregnancy & Breastfeeding use

Pregnancy Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Contraindication

Hypertension. Pregnancy. Patients with peripheral or mesenteric vascular thrombosis unless necessary as a life-saving procedure.

Acute Overdose

Symptoms: Hypertension, sweating, cerebral haemorrhage, convulsions.

Storage Condition

Store at room temperature (25°C) and protect from light.

Innovators Monograph

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