Norepinephrine
Levophed
Class:
Vasopressor
Vasopressor
Mechanism of Action:
Potent alpha-agonist resulting in intense peripheral vasoconstriction, positive chronotropic and increased inotropic effect with increased cardiac output. Alpha adrenergic activity resulting in peripheral vasoconstriction and beta-adrenergic activity leading to inotropic stimulation of the heart and coronary artery vasodilation.
Potent alpha-agonist resulting in intense peripheral vasoconstriction, positive chronotropic and increased inotropic effect with increased cardiac output. Alpha adrenergic activity resulting in peripheral vasoconstriction and beta-adrenergic activity leading to inotropic stimulation of the heart and coronary artery vasodilation.
Indications:
- Cardiogenic shock unresponsive to fluid resuscitation
- Significant hypotension (<70 mmHg) states
- First line vasopressor in septic shock.
Contraindications:
- Hypotensive patients with hypovolemia
- Pregnancy (relative)
Adverse reactions:
Headache, anxiety, dizziness, restlessness, dyspnea, bradycardia, hypertension, dysrhythmias, chest pain, peripheral cyanosis, cardiac arrest, nausea, vomiting, urinary retention, renal failure, decressed blood flow to the GI tract, kidneys and skeletal muscle and skin, tissue necrosis for extravasation.
Headache, anxiety, dizziness, restlessness, dyspnea, bradycardia, hypertension, dysrhythmias, chest pain, peripheral cyanosis, cardiac arrest, nausea, vomiting, urinary retention, renal failure, decressed blood flow to the GI tract, kidneys and skeletal muscle and skin, tissue necrosis for extravasation.
Can be deactivated by alkaline solutions. Sympathomimetic and phosphodiesterase inhibitors may exacerbate dysrhythmias.
Adult Dosage and Administration
0.1-0.5 mcg/kg/min titrating to a BP of 90 systolic.
MUST BE ON AN INFUSION PUMP
0.1-0.5 mcg/kg/min titrating to a BP of 90 systolic.
MUST BE ON AN INFUSION PUMP
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Pediatric Dosage and Administration:0.1-2 mcg/kg/min, titrate rate to achieve desired change in BP and systemic perfusion.
MUST BE ON AN INFUSION PUMP
Special Considerations:
- Pregnancy safety: Category C
- Use cautiously during pregnancy and while breastfeeding. May cause fetal anoxia when used in pregnancy.
- Infuse norepinephrine through a large, stable vein to avoid extravasation and tissue necrosis.
- Drug or poison induced hypotension may require higher doses to achieve adequate perfusion.