Norepinephrine

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
  • 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

See Also

• Undifferentiated shock

External Links

• EMCRIT Podcast - Peripheral Vasopressors