Page 167 - 2023 SMOG Digital

NOREPINEPHRINE Lactation? (Caution) Trade Name: Levophed
Class / Mechanism of Action
Alpha and Beta Agonist
Stimulates beta-1 and alpha adrenergic receptors: increases contractility, heart rate, and vasoconstriction.
Increases systemic blood pressure and coronary blood flow. Effects on vasoconstriction (alpha receptors)
are greater than inotropic (beta receptors). Onset of action: IV very rapid. Duration: 1-2min
Indications
Labeled Indications: Treatment of shock persisting after adequate fluid volume replacement; severe
hypotension.
ALS 2020: Severe cardiogenic shock and hemodynamically significant hypotension (SBP <70mmHg) with
low total peripheral resistance. Agent of last resort for management of ischemic heart disease and shock.
Contraindications
• Hypersensitivity to norepinephrine, bisulfites or any component of the formulation
• Hypotension from hypovolemia except as an emergency measure to maintain coronary and cerebral
perfusion until volume can be replaced
Adverse Reactions / Precautions
• No applicable use in hemorrhagic shock unless fluid replacement therapy maximized!
Maximize use of Blood products/Crystalloids before considering use in hemorrhagic shock.
• Strong Vesicant; ensure proper catheter placement and avoid extravasation, use a large vein
(preferably a central line) and avoid leg veins.
• Assure adequate circulatory volume to minimize need for vasoconstrictors. Monitor BP closely, avoid
hypertension and adjust infusion rate as needed.
Dose and Administration: ADULT PEDIATRIC
Hypotension/shock: Hypotension/shock:
IV: Administer as continuous infusion with infusion pump. Do not use in IV: Continuous infusion
same line as sodium bicarbonate. It will inactivate norepinephrine. • Initial: 0.05-0.1mcg/kg/
• Initial: 2-20mcg/min; titrate to SBP goal. min; titrate to effect
o Maintenance: 2-4mcg/min o Max dose: 2 mcg/kg/
min
Post ROSC Hypotension:
• Initial: 0.1-0.5mcg/kg/min titrate to effect.
If unable to maintain MAP >60mmHg, add Epinephrine infusion.
Use in Burn Patient:
For Burn patients, norepinephrine is only used when target MAP (>55) and
UOP (>30mL/hr) fail to be reached with fluid resuscitation alone. Its
sequence of use follows administration of Vasopressin.

(See infusion chart next page for mix and dosage information)

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