Name: NOREPINEPHRINE (LevophedR)
Classification: sympathomimetic, vasopressor
  • stimulates alpha adrenergic receptors, producing vasoconstriction and decreased heart rate
  • at low doses, stimulates beta adrenergic receptors to enhance myocardial contractility
Dose:
  • beta/alpha:
    • 2.5 - 5 mcg/min by infusion, targeted to effect
  • alpha: 
    • > 5 mcg/min by infusion
    • dose is titrated to effect
Administration: IV Infusion:
8 mg/250mL dextrose 5%, normal saline 0.9% or Ringer's Lactate
  • Protect from light
  • Colour change from clear to brown indicates a loss of potency
  • Hypovolemia, hypoxemia and acidosis should be corrected concurrently with initiation of therapy
  • Should be weaned off
Adverse Effects:
  • inadvertent boluses may precipitate profound hypertension which may result in myocardial infarction, cerebral ischemia
  • norepinephrine alone, without inotropic therapy may worsen stroke volume in left ventricular dysfunction in patients with poor ejection fraction n by increasing systemic afterload
  • bradycardia (tachycardia may occur if hypovolemic or if afterload has been increased)
  • renal ischemia resulting in decreased urine output
  • mesenteric ischemia
  • increased blood glucose
  • extravasation of drug may cause tissue necrosis  (Rx with 5-15mg phentolamine in NS - see phentolamine monograph)
Drug Interactions:
  • norepinephrine + anaesthetics = increased risk of cardiac arrhythmias
Monitoring Therapy:
  • IV site
  • blood presure
  • continous heart rate and rhytym
  • urine output
  • urea, creatinine
  • central or mixed venous oxygen saturation
  • lactate
  • blood gases
  • cardiac index if monitored
  • SVRI if monitored
  • changes in skin colour or tempurature
  • chest pain
Adult Critical Care Protocol:
  • May be administered by IV infusion by a nurse in Adult Critical Care.
  • May be titrated by a nurse in Adult Critical Care.
  • Must be administered via central venous access device; in emergency situations may be temporarily infused through a peripheral vasuclar access device until a central venous line can be established.
  • Patient requires placement of an arterial line to monitor BP.
  • Continuous infusions must be administered by infusion device and the pump library must be enabled.
  • Should not be infused via the proximal injectate port (blue) of a pulmonary artery catheter. If this is the only available central venous line, it may be administered through the proximal injectate port but thermodilution cardiac output measurements must not be measured during infusion).


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: September 17, 2018

LHSCHealth Professionals

Last Updated September 20, 2018 | © 2007, LHSC, London Ontario Canada