Norepinephrine

Indications
 Intravenous
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.
Injection
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.

Reconstitution: Dilute with 5% glucose inj, with or without sodium chloride; dilution with sodium chloride inj alone is not recommended.
Incompatibility: Incompatible with alkali and oxidising agents, barbiturates, chlorphenamine, chlorothiazide, nitrofurantoin, novobiocin, phenytoin, sodium bicarbonate, sodium iodide, streptomycin, insulin.
Contraindications
 Hypertension. Pregnancy. Patients with peripheral or mesenteric vascular thrombosis unless necessary as a life-saving procedure.
Warnings / Precautions
 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.
Adverse Reactions
 Hypertension, headache, peripheral ischaemia, bradycardia, arrhythmias, anxiety, skin necrosis (with extravasation), dyspnoea, respiratory difficulty.
Overdose Reactions
 Symptoms: Hypertension, sweating, cerebral haemorrhage, convulsions.
Drug Interactions
 Guanethidine, methyldopa, reserpine, TCAs may increase pressor response to norepinephrine.
Potentially Fatal: Increased risk of arrhythmias with cocaine, cyclopropane or halogenated hydrocarbon anaesthetics. Hypertensive crisis may occur with MAOIs. Hypertensive effects may be increased by nonselective β-blockers.
See Below for More norepinephrine Drug Interactions
Mechanism of Actions
 Norepinephrine is a direct-acting sympathomimetic which stimulates β1- and α-adrenergic receptors. Its α-agonist effects cause vasoconstriction, thereby raising systolic and diastolic BP with reflex slowing of heart rate.
Onset: Rapid.
Duration: Short; stops within 1-2 min after discontinuing the infusion.
Absorption: Oral: Destroyed in the GI tract; SC: Poorly absorbed.
Distribution: Mainly localises in sympathetic nervous tissue; crosses the placenta but not the blood-brain barrier.
Metabolism: Metabolised in the liver and in other tissues by the enzymes catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO).
Excretion: Via urine (mainly as metabolites).
Storage Conditions
 Intravenous: Store at room temperature (25°C) and protect from light. Store in tight, light-resistant containers as norepinephrine is readily oxidised. Do not use if discoloured (e.g. pink, dark yellow, brown) or if there is a precipitate.
ATC Classification
 C01CA03 - norepinephrine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of heart failure.
Storage
 Intravenous: Store at room temperature (25°C) and protect from light. Store in tight, light-resistant containers as norepinephrine is readily oxidised. Do not use if discoloured (e.g. pink, dark yellow, brown) or if there is a precipitate.
Available As
  • Norepinephrine 4 mg

    • Subscribe for latest updates

    Subscribe to our e-mail newsletter to receive updates.

    One Response to Norepinephrine

    1. January 4, 2013 at 3:14 pm #

      This tool is very useful

      Reply

    Post Review about Norepinephrine


    Norepinephrine Containing Brands

    We are Developing Our database, More results coming soon.

    Norepinephrine is used in following diseases

    We are Developing Our database, More results coming soon.

    Drug - Drug Interactions of Norepinephrine

    We are Developing Our database, More results coming soon.