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# Norepinephrine
## Overview
Norepinephrine is a vasopressor and inotropic agent that acts primarily on alpha-adrenergic receptors, causing vasoconstriction and increasing systemic vascular resistance. It also has some beta-1 adrenergic effects, increasing cardiac output.
## Primary Indications
* Treatment of hypotension and shock, particularly septic shock and cardiogenic shock, when other treatments have failed to maintain adequate blood pressure.
## Adult Dosing
* **Initial:** 2 to 4 mcg/minute (or 0.01 to 0.02 mcg/kg/minute) IV infusion.
* **Titration:** Increase infusion rate by 2 to 4 mcg/minute increments every 5 to 15 minutes, as needed, to achieve target blood pressure.
* **Maintenance:** Doses typically range from 2 to 15 mcg/minute, but can go higher.
* **Maximum:** Doses up to 30 mcg/minute (0.3 mcg/kg/minute) have been used in severe cases, but higher doses are associated with increased risk. Titrate to the lowest effective dose.
## Pediatric Dosing
* **Initial:** 0.05 to 0.1 mcg/kg/minute IV infusion.
* **Titration:** Increase by 0.05 to 0.2 mcg/kg/minute increments
