Norepinephrine*

• Norepinephrine

• Levophed

Classification:

• Sympathomimetic

Mechanism of Action:

• Stimulates alpha and beta receptors, primarily alpha
• + inotrope
• + Chronotrope
• Increases coronary artery blood flow
• Causes severe vasoconstriction (increasing SVR)

Indications:

• Septic shock
• Neurogenic shock
• Cardiogenic shock

Contraindications:

• Hypovolemia (hemorrhage, dehydration)

Precautions:

• Monitor BP every 2 - 5 min until stable
• Monitor Urinary Output
• Monitor IV site carefully, extravasations can cause necrosis, notify receiving
• Monitor perfusion of extremities
• Use cautiously in patients with cardiac history
• Use cautiously in the elderly
• Use cautiously in patients with hyperthyroidism

Adverse Effects:

• May increase myocardial ischemia

Dose:

• Mix 8 mg in 250 ml bag of D5W
• Initiate an infusion via infusion pump at 0.05 to 0.1 mcg/kg/min. Adjust infusion rate in increments of 0.05 to 0.1 mcg/kg/min as frequently as q1-5 min to achieve/maintain target blood pressure. The usual max dose is 1 mcg/kg/min.
  

• IV

• Norepinephrine must be given through an infusion pump.
• Most shock states require fluid administration prior to vasopressors therefore normal saline should be initiated prior to norepinephrine administration.
• It is recommended to administer a normal saline infusion by gravity with any norepinephrine infusion. To do this:
  • Initiate a normal saline infusion at a rate appropriate to patient condition via gravity (i.e., not through the pump)
  • Connect the norepinephrine infusion (via the pump) to the access port of the normal saline infusion line proximal to the patient
  • This will help as a driver when volumes of medication being infused are small
• Focus on fluid administration in patients with hypovolemic shock.
• Epinephrine is the vasopressor of choice within the EHS ground ambulance system for pediatric patients ≤ 16 years of age.
• May cause fetal anoxia when used in pregnancy.
• Pregnancy category D [potential benefits may warrant use of the drug in pregnant women despite potential risks (e.g., if it is required in a life-threatening situation)]

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Provider 2nd Edition