Please check your internet connection and try again.
# Norepinephrine
## Overview
Norepinephrine is a vasopressor and inotropic agent that stimulates alpha-1 adrenergic receptors, causing vasoconstriction and increasing peripheral vascular resistance and blood pressure. It also has some beta-1 adrenergic activity, increasing cardiac output.
## Primary Indications
* Treatment of hypotension, particularly in the setting of shock (e.g., septic shock, cardiogenic shock).
* Restoration and maintenance of adequate blood pressure.
## Adult Dosing
* **Initial Dosing:** Typically initiated at **2 to 10 mcg/minute** IV infusion.
* **Titration:** Doses are titrated to achieve a target mean arterial pressure (MAP) of **65 mmHg** or higher, or a specific systolic blood pressure as per institutional protocol. Doses may range from **0.01 to 3 mcg/kg/minute**.
* **Maximum Dose:** Doses up to **1 mcg/kg/minute** have been used in severe cases, but higher doses are associated with increased risk of adverse effects.
## Pediatric Dosing
* **Initial Dosing:** Typically **0.05 to 0.1 mcg/kg/minute** IV infusion.
* **Titration:** Doses are titrated to achieve a target MAP of **greater than or equal to the patient's age in years plus 70 mmHg** (for children over 1 year), or as per institutional protocol. Doses may range from **0.01 to 2 mcg/kg/minute**.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment is typically recommended, but caution and closer monitoring are advised due to potential accumulation.
* **Hepatic Impairment:** No specific dose adjustment is typically recommended, but caution and closer monitoring are advised.
* **Hypovolemia:** Norepinephrine should not be used as the primary treatment for hypovolemia. Volume resuscitation should be initiated first.
## Contraindications
* Hypersensitivity to norepinephrine.
* Should not be used as the sole agent to treat hypotension due to hypovolemia.
## Adverse Effects
* **Cardiovascular:** Hypertension, reflex bradycardia, arrhythmias, peripheral ischemia, extravasation leading to tissue necrosis.
* **Other:** Headache, anxiety, dizziness, tremors, dyspnea.
## Key Drug Interactions
* **Anesthetics:** May potentiate cardiac arrhythmias and increase blood pressure.
* **MAO Inhibitors and Tricyclic Antidepressants:** May prolong and intensify the pressor response; concurrent use is generally contraindicated.
* **Beta-blockers:** May cause unopposed alpha-stimulation, leading to severe hypertension.
* **Oxytocics:** May cause severe sustained hypertension.
## Monitoring
* Continuous blood pressure monitoring is essential.
* Heart rate and rhythm.
* Central venous pressure (if available).
* Urine output.
* Assess peripheral perfusion and signs of extravasation.
## Clinical Pearls
* Always use an infusion pump for accurate titration.
* Administer via a central venous catheter whenever possible to minimize the risk of extravasation.
* If extravasation occurs, discontinue infusion immediately and infiltrate the area with **phentolamine mesylate**.
* Norepinephrine is light-sensitive; protect the infusion from light.
***
*This information is intended for healthcare professionals. Please verify the most current prescribing information with the manufacturer's product information and relevant clinical guidelines before making treatment decisions.*
