Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

norepinephrine (Rx)Brand and Other Names:Levarterenol, Levophed

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 1mg/mL
more...

Acute Hypotension

Initial: 8-12 mcg/min IV infusion; titrate to effect

Maintenance: 2-4 mcg/min IV infusion

Cardiac Arrest

Initial: 8-12 mcg/min IV infusion; titrate to effect

Maintenance: 2-4 mcg/min IV infusion

Sepsis & Septic Shock

0.01-3 mcg/kg/min IV infusion 

Beta Blocker Toxicity (Off-label)

Should be titrated to age-appropriate blood pressure

Calcium Channel Blocker Toxicity (Off-label)

Should be titrated to age-appropriate blood pressure

Tricyclic Antidepressant Toxicity (Off-label)

Should be titrated to age-appropriate blood pressure

Dosage Forms & Strengths

injectable solution

  • 1mg/mL
more...

Acute Hypotension

Initial: 0.05-0.1 mcg/kg/min IV infusion; titrate to effect 

Maximum: 1-2 mcg/kg/min

Cardiac Arrest

Initial: 0.05-0.1 mcg/kg/min IV infusion; titrate to effect 

Maximum: 1-2 mcg/kg/min

Shock

0.05-0.1 mcg/kg/min IV infusion; titrate to effect; not to exceed 2 mcg/kg/min 

Next

Interactions

Interaction Checker

norepinephrine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            Frequency Not Defined

            Bradycardia

            Hypertension

            Arrhythmias

            Confusion

            Anxiety

            Dyspnea, with or without respiratory difficulty

            Headache

            Nausea and vomiting

            Sweating

            Tremor

            Restlessness

            Urinary retention

            Extravasation

            Gangrene

            Previous
            Next

            Warnings

            Black Box Warnings

            Antidote for extravasation ischemia: To prevent sloughing and necrosis in areas where extravasation has taken place, infiltrate areas promptly with 10-15 mL of saline solution containing 5-10 mg of phentolamine mesylate for injection

            Use syringe with fine hypodermic needle, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, pallid appearance

            Contraindications

            Hypersensitivity

            Hypotension due to blood volume deficit

            Peripheral vascular thrombosis (except for lifesaving procedures)

            Concomitant use with some general anesthetics: Chloroform, trichloroethylene, cyclopropane, halothane

            Cautions

            Mesenteric or peripheral vascular thrombosis

            Avoid infusion site extravasation

            Not for use in profound hypoxia

            Sulfite allergy due to presence of metabisulfite

            Monitor blood pressure

            Extreme caution in concurrent monoamine oxidase inhibitor (MAOI) use

            Previous
            Next

            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Not known if excreted into breast milk; avoid use during breastfeeding

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next

            Pharmacology

            Mechanism of Action

            Strong beta1- and alpha-adrenergic effects and moderate beta2 effects, which increase cardiac output and heart rate, decrease renal perfusion and PVR, and cause variable BP effects

            Absorption

            Onset: 1-2 min

            Duration: 1-2 min (vasopressor)

            Metabolism

            Metabolized by MAO and catechol-O-methyl transferase (COMT) in the adrenergic neuron

            Metabolites: Normetanephrine, vanillylmandelic acid (inactive)

            Elimination

            Excretion: Urine (84-96%)

            Previous
            Next

            Administration

            IV Incompatibilities

            Additive: Aminophylline, pentobarbital

            Not spec: Atropine, carbenicillin, cefazolin, diazepam

            IV Compatibilities

            Additive: Calcium gluconate, cimetidine, dobutamine, heparin, KCl, verapamil, vitamins B/C

            Syringe: Heparin

            Y-site: Amiodarone, epinephrine, esmolol, fentanyl, furosemide, heparin, hydrocortisone, KCl, vitamins B/C

            Not spec: Tetracycline

            IV Preparation

            Solution: 4 mg in 1000 ml D5W (4 mcg/ml); 40 ml/hr (~3 mcg/min); dose may be titrated to patient response

            IV Administration

            Into large vein; central line required

            Do not administer NaHCO3 through an IV line containing norepinephrine

            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.