Generic
Norepinephrine (Noradrenaline)
2 brands available in the market
At a glance
Norepinephrine (Noradrenaline) is a direct-acting sympathomimetic used for acute hypotension, cardiac arrest, sepsis and septic shock. It stimulates alpha and beta-adrenergic receptors to cause vasoconstriction and increase blood pressure.
Description
Norepinephrine is a direct-acting sympathomimetic which stimulates alpha 1- and beta-adrenergic receptors. Its alpha-agonist effects cause vasoconstriction, thereby raising systolic and diastolic BP with reflex slowing of heart rate.
Indications
- Acute hypotension
- Cardiac arrest
- Sepsis and septic shock
Pharmacological class
Sympathomimetic
Pharmacology
Norepinephrine stimulates α1-receptors to cause vasoconstriction and β1-receptors to increase cardiac output, rapidly raising blood pressure.
Mechanism of action
Restores blood pressure through vasoconstriction and increased cardiac output.
Dosage
Adult Dose (IV):
- Acute Hypotension/Cardiac Arrest: 8-12 mcg/min IV infusion (initial); titrate to effect; Maintenance: 2-4 mcg/min
- Sepsis/Septic Shock: 0.01-3 mcg/kg/min IV infusion
Pediatric Dose (IV):
- 0.05-0.1 mcg/kg/min IV infusion (initial); titrate to effect; max 1-2 mcg/kg/min
Administration
- Prepare 4 mcg/mL solution in glucose 5% or sodium chloride 0.9% and glucose 5%
- Infuse at 2-3 mL/minute; adjust according to BP response
- Infuse via central venous catheter or large vein
Missed dose
Not generally applicable (scheduled administration); consult doctor if needed.
Drug interactions
- Guanethidine, methyldopa, reserpine, TCAs may increase pressor response
- Increased risk of arrhythmias with cocaine, cyclopropane or halogenated hydrocarbon anaesthetics
- Hypertensive crisis with MAOIs
- Hypertensive effects may be increased by nonselective β-blockers
Food interactions
No food interactions (IV administration).
Contraindications
- Hypersensitivity
- Hypertension
- Pregnancy
- Peripheral or mesenteric vascular thrombosis (unless life-saving)
- Concurrent use with chloroform, trichloroethylene, cyclopropane, halothane
Side effects
Side Effects:
- Hypertension
- Headache
- Peripheral ischaemia
- Bradycardia
- Arrhythmias
- Anxiety
- Skin necrosis (with extravasation)
- Dyspnoea, respiratory difficulty
Use in pregnancy
Use in Pregnancy: Norepinephrine may be unsafe during pregnancy (Category C); use only if clearly needed.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Unknown if excreted in breast milk; avoid use during breastfeeding.
Precautions & warnings
- Not a substitute for blood, plasma, fluids and/or electrolyte replacement; correct volume depletion prior to administration
- Identify and correct hypoxia, hypercapnia and acidosis
- Avoid extravasation (tissue necrosis may occur)
- Avoid injection into leg veins (especially elderly or vascular disease patients)
- Caution in hypertensive or hyperthyroid patients
- Do not use in fingers, toes, ears, nose or genitalia with local anaesthetics
Pediatric use
Safety and effectiveness not established in children.
Geriatric use
Avoid infusion into leg veins in elderly patients; dose selection should be cautious.
Renal / hepatic impairment
Renal Impairment: Caution in kidney disease; dose adjustment may be needed.
Hepatic Impairment: Caution in liver disease; dose adjustment may be needed.
Overdose effects
Overdose: Headache, severe hypertension, reflex bradycardia, marked increase in peripheral resistance, decreased cardiac output; discontinue if excessive blood pressure elevation occurs.
Therapeutic class
Alpha and Beta-adrenergic Agonist
Storage conditions
Store at a temperature not exceeding 30°C in a dry place; protect from light.
Chemical structure
Norepinephrine (Noradrenaline)