Norepinephrine

General

  • Type: Vasopressors
  • Dosage Forms:
  • 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:
  • 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

See Also

External Links

References

  1. ZUCKER G. et al. Treatment of shock and prevention of ischemic necrosis with levarterenol-phentolamine mixtures. Circulation. 1960 Nov;22:935-7.
  2. PELNER L. et al. The problem of levarterenol (norepinephrine) extravasation an experimental study.. Am J Med Sci. 1958 Dec;236(6):755-66