Generic
Norepinephrine (Noradrenaline)
3 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
Therapeutic class
Alpha and Beta-adrenergic Agonist
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.
Side effects
Side Effects:
- Hypertension
- Headache
- Peripheral ischaemia
- Bradycardia
- Arrhythmias
- Anxiety
- Skin necrosis (with extravasation)
- Dyspnoea, respiratory difficulty
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
Contraindications
- Hypersensitivity
- Hypertension
- Pregnancy
- Peripheral or mesenteric vascular thrombosis (unless life-saving)
- Concurrent use with chloroform, trichloroethylene, cyclopropane, halothane
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).
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.
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.
Storage conditions
Store at a temperature not exceeding 30°C in a dry place; protect from light.
Chemical structure
Norepinephrine (Noradrenaline)