Please check your internet connection and try again.
# Norepinephrine
## Overview
Norepinephrine is a potent catecholamine possessing both alpha-1 adrenergic (vasoconstriction) and beta-1 adrenergic (inotropic) activity. It is the first-line vasopressor for septic shock.
## Primary Indications
* Acute hypotensive states (e.g., septic, cardiogenic, neurogenic shock).
* Adjunct in the treatment of cardiac arrest (off-label).
## Adult Dosing
* **Initial:** 0.05–0.1 mcg/kg/min or 2–4 mcg/min via continuous IV infusion.
* **Titration:** Titrate to achieve target Mean Arterial Pressure (MAP), typically ≥65 mmHg.
* **Maintenance:** 0.01–3 mcg/kg/min.
* **Note:** Dosing varies widely by institutional protocol; follow local sepsis bundles.
## Pediatric Dosing
* **Initial:** 0.05–0.1 mcg/kg/min via continuous IV infusion.
* **Titration:** Titrate by 0.05–0.1 mcg/kg/min every 5–15 minutes as needed.
* **Max:** Generally up to 1–2 mcg/kg/min (refer to institutional guidelines).
## Dose Adjustments
No specific dosage adjustments provided for renal or hepatic impairment; however, monitor closely as clearance may be altered in organ failure.
## Contraindications
* Hypersensitivity to norepinephrine or any component of the formulation.
* Hypotension due to uncorrected blood volume depletion (replace volume prior to initiation).
* Thrombosis (mesenteric or peripheral vascular).
## Adverse Effects
* **Cardiovascular:** Hypertension, arrhythmias (bradycardia or tachycardia), myocardial ischemia.
* **Local:** Extravasation can lead to skin necrosis and sloughing (treat with phentolamine).
* **Other:** Anxiety, headache, respiratory difficulty, decreased organ perfusion (if dose is excessive).
## Key Drug Interactions
* **MAO Inhibitors / TCAs:** May cause severe, prolonged hypertension.
* **Beta-Blockers:** May decrease the efficacy of norepinephrine and lead to unopposed alpha-mediated vasoconstriction.
* **General Anesthetics (e.g., cyclopropane, halothane):** Increase cardiac sensitivity to catecholamines, increasing risk of arrhythmias.
## Monitoring
* Continuous ECG monitoring (arrhythmia detection).
* Continuous blood pressure monitoring (arterial line preferred).
* Peripheral perfusion (check for skin mottling or cold extremities).
* Fluid status and urine output (indicator of organ perfusion).
## Clinical Pearls
* **Administration:** Must be administered via a central venous catheter whenever possible to reduce the risk of extravasation injury.
* **Compatibility:** Administer through a dedicated line if possible; highly pH sensitive.
* **Duration:** Wean slowly to avoid rebound hypotension.
* **Incompatibility:** Do not mix with alkaline solutions (e.g., sodium bicarbonate).
***
**Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution. Always verify specific dosing, safety precautions, and compatibility with current prescribing information, institutional protocols, and a licensed clinician before administration.
