Norepinephrine

Intravenous
Acute hypotensive states

Dilute with dextrose 5% in water, dextrose 5% in water and NaCl 0.9%, or NaCl 0.9% (however, dilution in NaCl 0.9% is not recommended) up to a final concentration of 4-64 mcg/mL. Premixed solutions for IV infusion are also available. Instructions for reconstitution may vary among countries and individual products. Refer to specific product guidelines.

Incompatible with alkali and oxidising agents, barbiturates, chlorphenamine, chlorothiazide, nitrofurantoin, novobiocin, phenytoin, Na bicarbonate, Na iodide, streptomycin, and insulin.

Concomitant use with halothane and cyclopropane anaesthetics.

Patient with profound hypoxia or hypercarbia; coronary mesenteric or peripheral vascular thrombosis, Prinzmetal's angina, diabetes, hypertension, hyperthyroidism; ischaemic heart disease, elevated intracranial pressure; hypotension after a MI. Not for use in patients with hypotension associated with hypovolaemia; correct hypovolaemia prior to administration. Blood volume replacement can be given before and/or during use of norepinephrine; however, for cases wherein whole blood or blood plasma is needed to increase the blood volume, administer separately. Avoid abrupt withdrawal. Obese patient. Hepatic and severe renal impairment. Neonates and elderly. Pregnancy and lactation.

Significant: Extravasation (may lead to tissue necrosis); severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, tissue hypoxia, lactic acidosis, and decreased systemic blood flow even with normal blood pressure (continuous administration in the absence of blood volume replacement); ventricular tachycardia or fibrillation (patient with profound hypoxia or hypercarbia); plasma volume depletion (prolonged administration); severe hypotension (abrupt withdrawal); gangrene of the extremities.
Cardiac disorders: Bradycardia, cardiogenic shock, stress cardiomyopathy, focal myocarditis.
Eye disorders: Acute glaucoma.
Gastrointestinal disorders: Nausea, vomiting.
Investigations: ECG change.
Nervous system disorders: Headache, dizziness, tremor.
Psychiatric disorders: Anxiety, insomnia.
Respiratory, thoracic and mediastinal disorders: Dyspnoea.
Vascular disorders: Hypertension, peripheral ischaemia, gangrene.
Potentially Fatal: Cardiac arrhythmias, ventricular tachycardia and ventricular fibrillation.

IM/IV/Parenteral: C

Monitor vital signs, blood pressure (alternatively, mean arterial pressure), heart rate, intravascular volume status, urine output, peripheral perfusion; cardiac output, pulmonary capillary wedge pressure (as necessary). Assess infusion site for signs of extravasation.

Symptoms: Severe hypertension, reflex bradycardia, marked increase in peripheral resistance and reduced cardiac output, cerebral haemorrhage, photophobia, pallor, intense sweating, vomiting, retrosternal pain, and severe headache. Management: Symptomatic and supportive treatment.

Increased risk of severe, prolonged hypertension with MAOIs, Linezolid, and TCAs.
Potentially Fatal: Increased risk of tachycardia or ventricular fibrillation with halogenated anaesthetics (e.g. cyclopropane, desflurane, isoflurane).

Description:
Mechanism of Action: Norepinephrine is a sympathomimetic amine. It is an α-adrenergic receptor agonist that causes peripheral vasoconstriction and a β₁ agonist as an inotropic stimulator of the heart and dilator of coronary arteries, thereby increasing systemic blood pressure and coronary artery blood flow.
Synonym(s): Noradrenaline.
Onset: Rapid.
Duration: Vasopressor: 1-2 minutes.
Pharmacokinetics:
Distribution: Crosses the placenta but does not readily penetrate the blood-brain barrier. Volume of distribution: 8.8 L. Plasma protein binding: Approx 25% mainly to albumin with smaller portion to prealbumin and α1-acid glycoprotein.
Metabolism: Extensively metabolised via methylation by COMT and via deamination by monoamine oxidase (MAO) into the major inactive metabolites 4-hydroxy-3-methoxymandelic acid and normetanephrine.
Excretion: Via urine (as metabolites; small amount as unchanged drug). Elimination half-life: Approx 2-4 minutes.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 439260, Norepinephrine. https://pubchem.ncbi.nlm.nih.gov/compound/Norepinephrine. Accessed Nov. 21, 2023.

Store between 15-30°C. Protect from light. Diluted solution: Store between 20-25°C. Protect from light. Storage recommendations may vary among countries and individual products. Refer to specific product guidelines.

Thuốc co mạch

C01CA03 - norepinephrine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of hypotension.

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