Norepinephrine: Difference between revisions
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==General== | ==General== | ||
*Type: [[Vasopressors]] | *Type: [[Is DrugClass::Vasopressors]] | ||
*Dosage Forms: | *Dosage Forms: IV | ||
*Common Trade Names: Levophed | *Common Trade Names: Levophed | ||
==Adult Dosing== | ==Adult Dosing== | ||
===Dosing=== | ===Dosing=== | ||
*Usual Adult Dose for Hypotension. Initial dose: 2 to 4 mcg/min with titration to 25 mcg/min | |||
''Based on Glomerular Filtration Rate [GFR (ml/min)]'' | ''Based on Glomerular Filtration Rate [GFR (ml/min)]'' | ||
*<10: 0.2mcg/kg/min | *<10: 0.2mcg/kg/min | ||
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==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Hypotension/Shock | |||
**IV Infusion: Initiate at 0.05-0.1mcg/kg/min, titrate to effect, usual max dose 2mcg/kg/min | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*Lactation: | *Lactation: Unknown if excreted in breast milk | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult | ||
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==Adverse Reactions== | ==Adverse Reactions== | ||
*If extravasation occurs use phentolamine 0.1 to 0. | *If extravasation occurs use [[phentolamine]] 0.1 to 0.2mg/kg (maximum dose 10mg) subcutaneous in affected site<ref>ZUCKER G. et al. Treatment of shock and prevention of ischemic necrosis with levarterenol-phentolamine mixtures. Circulation. 1960 Nov;22:935-7.</ref><ref>PELNER L. et al. The problem of levarterenol (norepinephrine) extravasation an experimental study.. Am J Med Sci. 1958 Dec;236(6):755-66</ref> | ||
**Consult plastic/general surgery service to follow the patient and eval for need for intervention | **Consult plastic/general surgery service to follow the patient and eval for need for intervention | ||
*Cardiovascular: Bradycardia, Arrhythmia, Cardiomyopathy | |||
*CNS Anxiety, Headache | |||
*Respiratory: Dyspnea | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: Effects for 1-2min | ||
*Metabolism: | *Metabolism: In the blood via COMT and MAO | ||
*Excretion: | *Excretion: Renal | ||
*Mechanism of Action: | *Mechanism of Action: | ||
===Primary Receptor=== | ===Primary Receptor=== | ||
* | *α<sub>1</sub> >> β<sub>1</sub> | ||
===Relative Effects=== | ===Relative Effects=== | ||
*↑↑↑SVR | *↑↑↑SVR | ||
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==Notes== | ==Notes== | ||
More potent vasoconstrictor than dopamine and phenylephrine. | More potent vasoconstrictor than [[dopamine]] and phenylephrine. | ||
===Indication=== | ===Indication=== | ||
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*Cardiogenic shock: | *Cardiogenic shock: | ||
**If marked hypotension (SBP <70) | **If marked hypotension (SBP <70) | ||
**If used with dobutamine | **If used with [[dobutamine]] | ||
==See Also== | ==See Also== | ||
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<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:Critical Care]] | |||
Latest revision as of 16:01, 25 July 2025
General
- Type: Vasopressors
- Dosage Forms: IV
- Common Trade Names: Levophed
Adult Dosing
Dosing
- Usual Adult Dose for Hypotension. Initial dose: 2 to 4 mcg/min with titration to 25 mcg/min
Based on Glomerular Filtration Rate [GFR (ml/min)]
- <10: 0.2mcg/kg/min
- 10-40: 0.3mcg/kg/min
- >40-50: 0.4mcg/kg/min
- For CVVHD: dose at 0.4mcg/kg/min
- For HD: dose 0.2mcg/kg/min
Rate of Titration
- Q2-5 min
Pediatric Dosing
- Hypotension/Shock
- IV Infusion: Initiate at 0.05-0.1mcg/kg/min, titrate to effect, usual max dose 2mcg/kg/min
Special Populations
- Pregnancy Rating: C
- Lactation: Unknown if excreted in breast milk
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
Adverse Reactions
- If extravasation occurs use phentolamine 0.1 to 0.2mg/kg (maximum dose 10mg) subcutaneous in affected site[1][2]
- Consult plastic/general surgery service to follow the patient and eval for need for intervention
- Cardiovascular: Bradycardia, Arrhythmia, Cardiomyopathy
- CNS Anxiety, Headache
- Respiratory: Dyspnea
Pharmacology
- Half-life: Effects for 1-2min
- Metabolism: In the blood via COMT and MAO
- Excretion: Renal
- Mechanism of Action:
Primary Receptor
- α1 >> β1
Relative Effects
- ↑↑↑SVR
- ↑HR
- ↑SV
Notes
More potent vasoconstrictor than dopamine and phenylephrine.
Indication
- Septic shock (1st line)
- Cardiogenic shock:
- If marked hypotension (SBP <70)
- If used with dobutamine