No

Alpha/Beta Agonist

Treatment of shock which persists after adequate fluid volume replacement

D

Hypersensitivity to norepinephrine, bisulfites (contains metabisulfite), or any component of the product; hypotension from hypovolemia except as an emergency measure to maintain coronary and cerebral perfusion until volume could be replaced; mesenteric or peripheral vascular thrombosis unless it is a lifesaving procedure; during anesthesia with cyclopropane or halothane anesthesia (risk of ventricular arrhythmias); pregnancy

Assure adequate circulatory volume to minimize need for vasoconstrictors. Avoid hypertension; monitor blood pressure closely and adjust infusion rate. Infuse into a large vein if possible. Avoid infusion into leg veins. Watch I.V. site closely. Avoid extravasation. Never use leg veins for infusion sites.

>10%:

Central nervous system: Headache

Gastrointestinal: Nausea, vomiting

1% to 10%:

Cardiovascular: Premature ventricular beats, bradycardia, hypertension, hypotension, chest pain, palpitations, tachycardia, ventricular arrhythmias

Central nervous system: Nervousness or restlessness

Respiratory: Dyspnea

Symptoms of overdose include hypertension, sweating, cerebral hemorrhage, convulsions

Treatment of extravasation: Infiltrate area of extravasation with phentolamine 5-10 mg in 10-15 mL of saline solution

Beta-blockers (nonselective ones) may increase hypertensive effect; avoid concurrent use.

Cocaine may cause malignant arrhythmias; avoid concurrent use.

Guanethidine can increase the pressor response; be aware of the patient's drug regimen.

MAO inhibitors potentiate hypertension and hypertensive crisis; avoid concurrent use.

Methyldopa can increase the pressor response; be aware of patient's drug regimen.

Reserpine increases the pressor response; be aware of patient's drug regimen.

TCAs increase the pressor response; be aware of patient's drug regimen.

Readily oxidized, protect from light, do not use if brown coloration; dilute with D₅W or DS/NS, but not recommended to dilute in normal saline; not stable with alkaline solutions; stability of parenteral admixture at room temperature (25°C): 24 hours

Stimulates beta₁-adrenergic receptors and alpha-adrenergic receptors causing increased contractility and heart rate as well as vasoconstriction, thereby increasing systemic blood pressure and coronary blood flow; clinically alpha effects (vasoconstriction) are greater than beta effects (inotropic and chronotropic effects)

Onset of action: I.V.: Very rapid-acting

Duration: Limited

Metabolism: By catechol-o-methyltransferase (COMT) and monoamine oxidase (MAO)

Elimination: In urine (84% to 96% as inactive metabolites)

Administration requires the use of an infusion pump!

Norepinephrine bitartrate 2 mg = Norepinephrine base 1 mg

Continuous I.V. infusion:

Children: Initial: 0.05-0.1 mcg/kg/minute; titrate to desired effect; maximum dose: 1-2 mcg/kg/minute

Adults: Initial: 4 mcg/minute and titrate to desired response; 8-12 mcg/minute is usual range; ACLS dosage range: 0.5-30 mcg/minute

Norepinephrine may cause acute increases in blood pressure because of vasoconstrictor actions. The drug should not be used in patients who are hypotensive because of hypovolemia. Furthermore, norepinephrine may precipitate ischemia or infarction in patients with peripheral vascular disease, mesenteric artery occlusions, and critical coronary artery lesions.

May cause anxiety, dizziness, or insomnia

Monitor for increased pressor effect when used with TCAs, MAOIs, and antihistamines

No information available to require special precautions

No effects or complications reported

This drug is used in emergency situations. Patient information is based on patient condition.

Central line administration required; do not administer NaHCO₃ through an I.V. line containing norepinephrine; administer into large vein to avoid the potential for extravasation; potent drug, must be diluted prior to use

Injection, as bitartrate: 1 mg/mL (4 mL)

Aron DC, Bravo EL, and Kapcala LP, "Erroneous Plasma Norepinephrine Levels With Radioimmunoassay," Ann Intern Med, 1983, 98(6):1023.

Cryer PE, "Physiology and Pathophysiology of the Human Sympathoadrenal Neuroendocrine System," N Engl J Med, 1980, 303(8):436-44.

Martin C, Papazian L, Perrin G, et al, "Norepinephrine or Dopamine for the Treatment of Hyperdynamic Septic Shock?" Chest, 1993, 103(6):1826-31.