Name

norepinephrine (Levophed®)

Class

Sympathomimetic

Description/Mechanism

Norepinephrine is an alpha and beta 1 adrenergic agonist. It is a potent vasoconstrictor that increases myocardial contractility and peripheral vascular resistance.

Onset

1-3 minutes

Duration

5-10 minutes

Indications

Inotropic support for SBP < 70 mmHg and signs of decompensation.

Hemodynamically significant hypotension refractory to other sympathomimetic amines

Contraindications

Hypotension associated with hypovolemia

Adverse Reactions

Headache

Dysrhythmias & tachycardias

Reflex bradycardia

Angina/Cardiac ischemia/infarction

Hypertension

Drug Interactions

Can be deactivated by alkaline solutions

MAO inhibitors and bretylium may potentiate the effects of catecholamines

Beta adrenergic antagonists may blunt inotropic response

Sympathomimetics and phosphodiesterase inhibitors may exacerbate dysrhythmia response

Supplied

1mg/ml, 4 ml ampules

Dose/Administration

Adult

IV infusion: 0.5 –30 mcg/min titrated to effect. Average adult dose is 2-12 mcg/min

Pediatric

Not recommended (epinephrine infusion preferred).

Special Consideration

Pregnancy Safety: D

May cause fetal anoxia when used in pregnancy

Infuse norepinephrine through a large stable vein to avoid tissue necrosis

Use infusion pump to ensure precise flow rate