Norepinephrine: Difference between revisions
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Latest revision as of 21:56, 20 March 2026
General
- Type: Vasopressors
- Dosage Forms: IV
- Common Trade Names: Levophed
Adult Dosing
Dosing
- Usual Adult Dose for Hypotension. Initial dose: 2 to 4 mcg/min with titration to 25 mcg/min
Based on Glomerular Filtration Rate [GFR (ml/min)]
- <10: 0.2mcg/kg/min
- 10-40: 0.3mcg/kg/min
- >40-50: 0.4mcg/kg/min
- For CVVHD: dose at 0.4mcg/kg/min
- For HD: dose 0.2mcg/kg/min
Rate of Titration
- Q2-5 min
Pediatric Dosing
- Hypotension/Shock
- IV Infusion: Initiate at 0.05-0.1mcg/kg/min, titrate to effect, usual max dose 2mcg/kg/min
Special Populations
- Pregnancy Rating: C
- Lactation: Unknown if excreted in breast milk
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
Adverse Reactions
- If extravasation occurs use phentolamine 0.1 to 0.2mg/kg (maximum dose 10mg) subcutaneous in affected site[1][2]
- Consult plastic/general surgery service to follow the patient and eval for need for intervention
- Cardiovascular: Bradycardia, Arrhythmia, Cardiomyopathy
- CNS Anxiety, Headache
- Respiratory: Dyspnea
Pharmacology
- Half-life: Effects for 1-2min
- Metabolism: In the blood via COMT and MAO
- Excretion: Renal
- Mechanism of Action:
Primary Receptor
- α1 >> β1
Relative Effects
- ↑↑↑SVR
- ↑HR
- ↑SV
Notes
More potent vasoconstrictor than dopamine and phenylephrine.
Indication
- Septic shock (1st line)
- Cardiogenic shock:
- If marked hypotension (SBP <70)
- If used with dobutamine
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Calcium channel blocker toxicity | Start 2 mcg/min, uptitrate rapidly to MAP ≥65 | Vasopressor (agent of choice) | IV drip | Adult |
| Sepsis (main) | 0.1-1 mcg/kg/min (typical start 5-20 mcg/min) | 1st line vasopressor | IV drip | Adult |
| Vasopressors | 2-5 mcg/min (0.01-0.03 mcg/kg/min), max 0.5-1 mcg/kg/min | 1st line vasopressor | IV drip | Adult |
| Vasopressors | 0.05-0.4mcg/kg/min (start 5-15mcg/min) | First-line vasopressor for septic shock | IV | Adult |