NOREPINEPHRINE (NORADRENALINE)

Sympathomimetic medicine. Norepinephrine is a hormone and neurotransmitter naturally produced by the body

Dosage Forms

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Injection

2 mg/ml

Uses

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  • Acute hypotension

Dose and Duration

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Acute hypotension

Adult: by continuous IV infusion, via central venous catheter, of a solution containing 0.04 mg/ml of noradrenaline base (equivalent to 0.08 mg/ml of noradrenaline tartarate) at an initial rate of 0.16–0.33 ml/minute, adjusted according to response

Neonate and child: by continuous IV infusion 0.02–0.1 micrograms/kg/minute as the base (equivalent to 0.04–0.2 microgram of noradrenaline tartarate) adjusted according to response up to a max of 1 microgram base (2 microgram noradrenaline tartarate)/kg/minute

Preparation

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  • For continuous IV infusion, dilute with dextrose 5% or sodium chloride and dextrose to a maximum concentration of noradrenaline base 40 mg/l (i.e. 80 mg/l of noradrenaline tartarate; higher concentrations can be used if patient is fluid-restricted). Incompatible with bicarbonate or alkaline solutions.

Contraindications

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  • Hypotension due to hypovolaemia

Side Effects

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  • Anorexia, nausea, vomiting
  • Arrhythmias, peripheral ischaemia, palpitation, hypertension, bradycardia, tachycardia
  • Dyspnoea, hypoxia
  • Confusion, anxiety, psychosis, insomnia, headache
  • Weakness, tremor
  • Urinary retention
  • Angle-closure glaucoma

Interactions

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  • Halothane, desflurane, isoflurane (increased risk of arrhythmias)
  • MAOIS (risk of hypertensive crisis)
  • Verapamil (enhanced hypotensive effect and atrioventricular delay)

Pregnancy

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  • Do not use

Breast-feeding

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  • Do not use

⚠️ Caution

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  • Monitor blood pressure and rate of flow frequently
  • Only use in conjunction with appropriate blood volume replacement fluids
  • Check infusion site frequently for extravasation, which can cause necrosis
  • Use in pregnancy may reduce placental perfusion and induce foetal bradycardia