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 D5W, NS, RL
  • 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 by increasing systemic afterload
  • bradycardia
  • 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:
  • BP
  • HR, ECG
  • urine output, BUN, creatinine
  • cardiac index
  • SVRI
  • arterial lactate
  • PWP
  • changes in skin colour or tempurature
  • chest pain
CCTC Protocol:
  • May be administered by IV infusion by an approved nurse in CCTC.
  • May be titrated by an approved nurse in CCTC.
  • Must be administered via a central line.
  • Continuous infusion must be administered via an infusion pump.
  • Should not be administered through the proximal injectate (blue) port of the Swan Ganz Catheter.
  • Patient requires placement of an arterial line to monitor BP.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: January 12, 2017

LHSCHealth Professionals

Last Updated January 12, 2017 | © 2007, LHSC, London Ontario Canada