Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 1mg/mL
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
0.01-3.3 mcg/kg/min IV infusion (Hollenberg 2009)
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
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (6)
- isocarboxazid
isocarboxazid increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- linezolid
linezolid increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- phenelzine
phenelzine increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- procarbazine
procarbazine increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- selegiline transdermal
selegiline transdermal increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
- tranylcypromine
tranylcypromine increases effects of norepinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Serious - Use Alternative (32)
- amitriptyline
amitriptyline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- amoxapine
amoxapine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- cabergoline
cabergoline, norepinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- clomipramine
clomipramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- desflurane
desflurane increases toxicity of norepinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
desflurane increases levels of norepinephrine by decreasing metabolism. Contraindicated. - desipramine
desipramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- dihydroergotamine
dihydroergotamine, norepinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- dihydroergotamine intranasal
dihydroergotamine intranasal, norepinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- doxapram
doxapram increases effects of norepinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.
- doxepin
doxepin, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ergoloid mesylates
ergoloid mesylates, norepinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ergotamine
ergotamine, norepinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ether
ether increases toxicity of norepinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- etomidate
etomidate increases levels of norepinephrine by decreasing metabolism. Contraindicated.
- imipramine
imipramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- iobenguane I 131
norepinephrine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- isoflurane
isoflurane increases toxicity of norepinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- ketamine
ketamine, norepinephrine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Intraoperative use of norepinephrine and ketamine should be used cautiously and is contraindicated in situations where increased blood pressure would be hazardous (eg, hypertension, stroke, head trauma, intracranial bleeding). .
- levomilnacipran
levomilnacipran increases levels of norepinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.
- lofepramine
lofepramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- maprotiline
maprotiline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- methoxyflurane
methoxyflurane increases toxicity of norepinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
- methylergonovine
methylergonovine, norepinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- milnacipran
milnacipran increases levels of norepinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.
- nortriptyline
nortriptyline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- ozanimod
ozanimod increases toxicity of norepinephrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- propofol
propofol increases levels of norepinephrine by decreasing metabolism. Contraindicated.
- protriptyline
protriptyline, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- sevoflurane
sevoflurane increases toxicity of norepinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.
sevoflurane increases levels of norepinephrine by decreasing metabolism. Contraindicated. - trazodone
trazodone, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- trimipramine
trimipramine, norepinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.
- yohimbe
yohimbe, norepinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.
Monitor Closely (249)
- acebutolol
acebutolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
acebutolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - aceclofenac
aceclofenac increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- acemetacin
acemetacin increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- albuterol
albuterol and norepinephrine both decrease serum potassium. Use Caution/Monitor.
albuterol and norepinephrine both decrease sedation. Use Caution/Monitor.
albuterol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - alfentanil
alfentanil increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alprazolam
alprazolam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amiloride
amiloride increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- amitriptyline
amitriptyline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amitriptyline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - amobarbital
amobarbital increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amoxapine
amoxapine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
amoxapine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - arformoterol
arformoterol and norepinephrine both decrease serum potassium. Use Caution/Monitor.
arformoterol and norepinephrine both decrease sedation. Use Caution/Monitor.
arformoterol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - aripiprazole
aripiprazole increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- armodafinil
norepinephrine and armodafinil both decrease sedation. Use Caution/Monitor.
- aspirin
aspirin increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aspirin rectal
aspirin rectal increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atenolol
atenolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
atenolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - atomoxetine
atomoxetine, norepinephrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as norepinephrine.
- azelastine
azelastine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- belladonna and opium
belladonna and opium increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bendroflumethiazide
norepinephrine and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.
- benperidol
benperidol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benzphetamine
norepinephrine and benzphetamine both decrease sedation. Use Caution/Monitor.
norepinephrine and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - betaxolol
betaxolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
betaxolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - bisoprolol
bisoprolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
bisoprolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - bretylium
bretylium increases effects of norepinephrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Modify Therapy/Monitor Closely. If catecholamines are administered to treat systolic BP <75 mmHg, a dilute solution should be employed and blood pressure monitored closely. Bretylium causes an initial norepinephrine release and may enhance catecholamine pressor effects.
- bromocriptine
bromocriptine, norepinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.
- brompheniramine
brompheniramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bumetanide
norepinephrine and bumetanide both decrease serum potassium. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butabarbital
butabarbital increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butalbital
butalbital increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butorphanol
butorphanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- caffeine
norepinephrine and caffeine both decrease sedation. Use Caution/Monitor.
- carbenoxolone
norepinephrine and carbenoxolone both decrease serum potassium. Use Caution/Monitor.
- carbinoxamine
carbinoxamine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carvedilol
carvedilol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
carvedilol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - celecoxib
celecoxib increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- celiprolol
celiprolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
celiprolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - chloral hydrate
chloral hydrate increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorothiazide
norepinephrine and chlorothiazide both decrease serum potassium. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpromazine
chlorpromazine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
chlorpromazine, norepinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - chlorthalidone
norepinephrine and chlorthalidone both decrease serum potassium. Use Caution/Monitor.
- choline magnesium trisalicylate
choline magnesium trisalicylate increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- cinnarizine
cinnarizine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clemastine
clemastine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clomipramine
clomipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
clomipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - clonazepam
clonazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clorazepate
clorazepate increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clozapine
clozapine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- codeine
codeine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclizine
cyclizine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclopenthiazide
norepinephrine and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.
- cyproheptadine
cyproheptadine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- deflazacort
norepinephrine and deflazacort both decrease serum potassium. Use Caution/Monitor.
- desipramine
desipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
desipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - dexchlorpheniramine
dexchlorpheniramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexfenfluramine
norepinephrine and dexfenfluramine both decrease sedation. Use Caution/Monitor.
norepinephrine and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dexmedetomidine
dexmedetomidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmethylphenidate
norepinephrine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.
norepinephrine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextroamphetamine
norepinephrine and dextroamphetamine both decrease sedation. Use Caution/Monitor.
norepinephrine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dextromoramide
dextromoramide increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diamorphine
diamorphine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diclofenac
diclofenac increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diethylpropion
norepinephrine and diethylpropion both decrease sedation. Use Caution/Monitor.
norepinephrine and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - difenoxin hcl
difenoxin hcl increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diflunisal
diflunisal increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- digoxin
digoxin increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenhydramine
diphenhydramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenoxylate hcl
diphenoxylate hcl increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dipipanone
dipipanone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dobutamine
dobutamine and norepinephrine both decrease serum potassium. Use Caution/Monitor.
dobutamine and norepinephrine both decrease sedation. Use Caution/Monitor.
dobutamine and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dopamine
norepinephrine and dopamine both decrease sedation. Use Caution/Monitor.
norepinephrine and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - dopexamine
dopexamine and norepinephrine both decrease serum potassium. Use Caution/Monitor.
dopexamine and norepinephrine both decrease sedation. Use Caution/Monitor.
dopexamine and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
dopexamine, norepinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. - doxepin
doxepin increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
doxepin increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - droperidol
droperidol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- drospirenone
drospirenone increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- droxidopa
norepinephrine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension
- entacapone
entacapone will increase the level or effect of norepinephrine by decreasing metabolism. Use Caution/Monitor. Entacapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.
- ephedrine
ephedrine and norepinephrine both decrease serum potassium. Use Caution/Monitor.
ephedrine and norepinephrine both decrease sedation. Use Caution/Monitor.
ephedrine and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
ephedrine, norepinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. - epinephrine
epinephrine and norepinephrine both decrease serum potassium. Use Caution/Monitor.
epinephrine and norepinephrine both decrease sedation. Use Caution/Monitor.
epinephrine and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - epinephrine racemic
norepinephrine and epinephrine racemic both decrease serum potassium. Use Caution/Monitor.
norepinephrine and epinephrine racemic both decrease sedation. Use Caution/Monitor.
norepinephrine and epinephrine racemic both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - esmolol
esmolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
esmolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - estazolam
estazolam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ethacrynic acid
norepinephrine and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.
- ethanol
ethanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- etodolac
etodolac increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fenfluramine
norepinephrine and fenfluramine both decrease sedation. Use Caution/Monitor.
norepinephrine and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - fenoprofen
fenoprofen increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fluphenazine
fluphenazine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
fluphenazine, norepinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - flurazepam
flurazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flurbiprofen
flurbiprofen increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- formoterol
formoterol and norepinephrine both decrease serum potassium. Use Caution/Monitor.
formoterol and norepinephrine both decrease sedation. Use Caution/Monitor.
formoterol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - furosemide
norepinephrine and furosemide both decrease serum potassium. Use Caution/Monitor.
- gentamicin
norepinephrine and gentamicin both decrease serum potassium. Use Caution/Monitor.
- green tea
green tea increases effects of norepinephrine by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.
- haloperidol
haloperidol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydralazine
hydralazine, norepinephrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.
- hydrochlorothiazide
norepinephrine and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.
- hydromorphone
hydromorphone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydroxyzine
hydroxyzine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen
ibuprofen increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen IV
ibuprofen IV increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- iloperidone
iloperidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- imipramine
imipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
imipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - indacaterol, inhaled
norepinephrine increases effects of indacaterol, inhaled by Other (see comment). Use Caution/Monitor. Comment: If additional adrenergic drugs are to be administered by any route, they should be used with caution because the sympathetic effects of indacaterol may be potentiated.
- indapamide
norepinephrine and indapamide both decrease serum potassium. Use Caution/Monitor.
- indomethacin
indomethacin increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- insulin degludec
norepinephrine decreases effects of insulin degludec by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.
- insulin degludec/insulin aspart
norepinephrine decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.
- insulin inhaled
norepinephrine decreases effects of insulin inhaled by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.
- ioflupane I 123
norepinephrine decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.
- isoproterenol
isoproterenol and norepinephrine both decrease serum potassium. Use Caution/Monitor.
isoproterenol and norepinephrine both decrease sedation. Use Caution/Monitor.
isoproterenol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ketoprofen
ketoprofen increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketorolac
ketorolac increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketorolac intranasal
ketorolac intranasal increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- ketotifen, ophthalmic
ketotifen, ophthalmic increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- labetalol
labetalol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
labetalol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - levalbuterol
levalbuterol and norepinephrine both decrease serum potassium. Use Caution/Monitor.
levalbuterol and norepinephrine both decrease sedation. Use Caution/Monitor.
levalbuterol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - levorphanol
levorphanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lisdexamfetamine
norepinephrine and lisdexamfetamine both decrease sedation. Use Caution/Monitor.
norepinephrine and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - lofepramine
lofepramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
lofepramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - lofexidine
lofexidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loprazolam
loprazolam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lorazepam
lorazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lormetazepam
lormetazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lornoxicam
lornoxicam increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine
loxapine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- loxapine inhaled
loxapine inhaled increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- maprotiline
maprotiline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
maprotiline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - marijuana
marijuana increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meclofenamate
meclofenamate increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mefenamic acid
mefenamic acid increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- melatonin
melatonin increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meloxicam
meloxicam increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meperidine
meperidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meprobamate
meprobamate increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaproterenol
metaproterenol and norepinephrine both decrease serum potassium. Use Caution/Monitor.
metaproterenol and norepinephrine both decrease sedation. Use Caution/Monitor.
metaproterenol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methadone
methadone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methamphetamine
norepinephrine and methamphetamine both decrease sedation. Use Caution/Monitor.
norepinephrine and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methyclothiazide
norepinephrine and methyclothiazide both decrease serum potassium. Use Caution/Monitor.
- methyldopa
methyldopa increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor.
- methylenedioxymethamphetamine
norepinephrine and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.
norepinephrine and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - methylphenidate
norepinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- metolazone
norepinephrine and metolazone both decrease serum potassium. Use Caution/Monitor.
- metoprolol
metoprolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
metoprolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - midazolam
midazolam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midodrine
norepinephrine and midodrine both decrease sedation. Use Caution/Monitor.
norepinephrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - mirtazapine
mirtazapine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- modafinil
norepinephrine and modafinil both decrease sedation. Use Caution/Monitor.
- morphine
morphine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- motherwort
motherwort increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moxonidine
moxonidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabilone
nabilone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabumetone
nabumetone increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nadolol
nadolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
nadolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - nalbuphine
nalbuphine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- naproxen
naproxen increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nateglinide
norepinephrine decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Coadministration may reduce nateglinide's hypoglycemic action.
- nebivolol
nebivolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
nebivolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - nortriptyline
nortriptyline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
nortriptyline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - olanzapine
olanzapine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olodaterol inhaled
norepinephrine and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects
- opicapone
opicapone will increase the level or effect of norepinephrine by decreasing metabolism. Use Caution/Monitor. Opicapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.
- opium tincture
opium tincture increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxaprozin
oxaprozin increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxazepam
oxazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxycodone
oxycodone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxymetazoline topical
oxymetazoline topical and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- oxymorphone
oxymorphone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxytocin
oxytocin increases effects of norepinephrine by pharmacodynamic synergism. Use Caution/Monitor.
- paliperidone
paliperidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- papaveretum
papaveretum increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- parecoxib
parecoxib increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- penbutolol
penbutolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - pentazocine
pentazocine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pentobarbital
pentobarbital increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- perphenazine
perphenazine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
perphenazine, norepinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - phendimetrazine
norepinephrine and phendimetrazine both decrease sedation. Use Caution/Monitor.
norepinephrine and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenobarbital
phenobarbital increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenoxybenzamine
phenoxybenzamine, norepinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.
- phentermine
norepinephrine and phentermine both decrease sedation. Use Caution/Monitor.
norepinephrine and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phentolamine
phentolamine, norepinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.
- phenylephrine
norepinephrine and phenylephrine both decrease sedation. Use Caution/Monitor.
norepinephrine and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - phenylephrine PO
norepinephrine and phenylephrine PO both decrease sedation. Use Caution/Monitor.
norepinephrine and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - pholcodine
pholcodine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
pimozide increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pindolol
pindolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
pindolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - pirbuterol
norepinephrine and pirbuterol both decrease serum potassium. Use Caution/Monitor.
norepinephrine and pirbuterol both decrease sedation. Use Caution/Monitor.
norepinephrine and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - piroxicam
piroxicam increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- potassium acid phosphate
potassium acid phosphate increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- potassium chloride
potassium chloride increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- potassium citrate
potassium citrate increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- primidone
primidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- prochlorperazine
prochlorperazine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
prochlorperazine, norepinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - promazine
promazine, norepinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.
- promethazine
promethazine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
promethazine, norepinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - propranolol
propranolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
propranolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - propylhexedrine
norepinephrine and propylhexedrine both decrease sedation. Use Caution/Monitor.
norepinephrine and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - protriptyline
protriptyline increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
protriptyline increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - pseudoephedrine
norepinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- quazepam
quazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quetiapine
quetiapine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- rasagiline
rasagiline increases effects of norepinephrine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.
- risperidone
risperidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sacubitril/valsartan
sacubitril/valsartan increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salicylates (non-asa)
salicylates (non-asa) increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salmeterol
norepinephrine and salmeterol both decrease serum potassium. Use Caution/Monitor.
norepinephrine and salmeterol both decrease sedation. Use Caution/Monitor.
norepinephrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - salsalate
salsalate increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scullcap
scullcap increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- secobarbital
secobarbital increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- selegiline
selegiline increases effects of norepinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.
- serdexmethylphenidate/dexmethylphenidate
norepinephrine and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- shepherd's purse
shepherd's purse increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
norepinephrine and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.
- solriamfetol
norepinephrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- sotalol
sotalol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
sotalol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - spironolactone
spironolactone increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- succinylcholine
succinylcholine increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sufentanil
sufentanil increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sulfasalazine
sulfasalazine increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sulindac
sulindac increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tapentadol
tapentadol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- temazepam
temazepam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- terbutaline
norepinephrine and terbutaline both decrease serum potassium. Use Caution/Monitor.
norepinephrine and terbutaline both decrease sedation. Use Caution/Monitor.
norepinephrine and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - thioridazine
thioridazine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
thioridazine, norepinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - thiothixene
thiothixene increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- timolol
timolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
timolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - tolcapone
tolcapone will increase the level or effect of norepinephrine by decreasing metabolism. Use Caution/Monitor. Tolcapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.
- tolfenamic acid
tolfenamic acid increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolmetin
tolmetin increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolvaptan
tolvaptan increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- topiramate
topiramate increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- torsemide
norepinephrine and torsemide both decrease serum potassium. Use Caution/Monitor.
- tramadol
tramadol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trazodone
trazodone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
trazodone increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - triamterene
triamterene increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- triazolam
triazolam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triclofos
triclofos increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trifluoperazine
trifluoperazine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
trifluoperazine, norepinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. - trimipramine
trimipramine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
trimipramine increases effects of norepinephrine by unknown mechanism. Use Caution/Monitor. - triprolidine
triprolidine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- xylometazoline
norepinephrine and xylometazoline both decrease sedation. Use Caution/Monitor.
norepinephrine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - yohimbine
norepinephrine and yohimbine both decrease sedation. Use Caution/Monitor.
norepinephrine and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. - ziconotide
ziconotide increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziprasidone
ziprasidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
Minor (16)
- bendroflumethiazide
norepinephrine, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- bumetanide
norepinephrine, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- chlorothiazide
norepinephrine, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- chlorthalidone
norepinephrine, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- cyclopenthiazide
norepinephrine, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- desmopressin
desmopressin increases effects of norepinephrine by pharmacodynamic synergism. Minor/Significance Unknown.
- ethacrynic acid
norepinephrine, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- eucalyptus
eucalyptus increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- furosemide
norepinephrine, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- hydrochlorothiazide
norepinephrine, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
hydrochlorothiazide decreases effects of norepinephrine by pharmacodynamic antagonism. Minor/Significance Unknown. May decrease responsiveness to norepinephrine but not enough to preclude effectiveness of the pressor agent therapeutic use. - indapamide
norepinephrine, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- methyclothiazide
norepinephrine, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- metolazone
norepinephrine, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
- noni juice
noni juice increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- sage
sage increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- torsemide
norepinephrine, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.
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
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
Patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed
Peripheral vascular thrombosis (except for lifesaving procedures)
Concomitant use with some general anesthetics cyclopropane (not available in the US), halothane (not available in the US)
Cautions
If therapy is continuously administered to maintain blood pressure in absence of blood volume replacement, severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis may occur
Use extreme caution with concurrent monoamine oxidase inhibitor (MAOI) use or antidepressants of the triptyline or imipramine types; severe, prolonged hypertension may result
Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and seem to sensitize the myocardium to action of intravenously administered epinephrine or norepinephrine
Not for use in profound hypoxia or hypercarbia
Bitartrate injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people
Because of potency of drug and because of varying response to pressor substances, possibility always exists that dangerously high blood pressure may be produced with overdoses of this pressor agent; it is desirable, therefore, to record blood pressure every two min from time administration is started until desired blood pressure is obtained, then every five min if administration is to be continued; rate of flow must be watched constantly, and patient should never be left unattended while receiving therapy; headache may be a symptom of hypertension due to overdosage
When possible, infusions should be given into large vein, particularly an antecubital vein to reduce risk of necrosis of overlying skin from prolonged vasoconstriction; some authors have indicated that femoral vein is an acceptable route of administration; occlusive vascular diseases (for example, atherosclerosis, arteriosclerosis, diabetic endarteritis, Buerger’s disease) are more likely to occur in the lower than in the upper extremity; one should avoid the veins of the leg in elderly patients or in those suffering from such disorders; gangrene has been reported in a lower extremity when infusions were given in an ankle vein
Infusion site should be checked frequently for free flow; care should be taken to avoid extravasation of drug into tissues, as local necrosis might ensue due to vasoconstrictive action of drug; blanching along the course of the infused vein, sometimes without obvious extravasation, has been attributed to vasa vasorum constriction with increased permeability of vein wall, permitting some leakage
Antidote for extravasation ischemia
- To prevent sloughing and necrosis in areas in which extravasation has taken place, area should be infiltrated as soon as possible with 10 - 15 mL of saline solution containing from 5 mg to 10 mg of Regitine® (brand of phentolamine), an adrenergic blocking agent; a syringe with a fine hypodermic needle should be used, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, and pallid appearance; sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours; therefore, phentolamine should be given as soon as possible after extravasation is noted.
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.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%)
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| norepinephrine bitartrate intravenous - | 1 mg/mL vial |  | |
| norepinephrine bitartrate intravenous - | 1 mg/mL solution |  | |
| norepinephrine bitartrate intravenous - | 1 mg/mL vial |  | |
| norepinephrine bitartrate intravenous - | 1 mg/mL vial |  | |
| norepinephrine bitartrate intravenous - | 1 mg/mL vial |  | |
| norepinephrine bitartrate intravenous - | 1 mg/mL vial |  | |
| norepinephrine bitartrate intravenous - | 1 mg/mL solution |  | |
| norepinephrine bitartrate intravenous - | 1 mg/mL vial |  | |
| Levophed intravenous - | 1 mg/mL vial |  | |
| Levophed intravenous - | 1 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
norepinephrine bitartrate intravenous
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
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.
