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

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 |
---|---|---|---|
Levophed intravenous - | 1 mg/mL vial | ![]() | |
Levophed 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 | ![]() | |
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 | ![]() |
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) 2022 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
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