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NORepinephrine

Classification

High Alert Medication
Sympathomimetic

Indications

PCFP/ACFP/CCP: Management of shock with hypotension refractory to fluid resuscitation

PCFP/ACFP/CCP: Management of cardiogenic shock with refractory hypotension

Contraindications

Pheochromocytoma
Pregnancy

Adult dosages

PCFP/ACFP/CCP: All indications

Infusion

Initial: 5-15mcg/min
- Titrate every 5-15 minutes to achieve target MAP greater than 65mmhg
Usual maintenance
- 2 - 50 mcg/min

PCFP: Restricted operational scope. ☎️CCP-A consultation required to establish care plan with clinical advisory group including medical oversight
ACFP: ☎️ CCP-A consultation required

Pediatric Considerations And Dosing

Follow weight-based dosing

ACFP/CCP: All indications

0.1 mcg/kg/minute IV/IO
Titrate upwards to a maximum of 1 mcg/kg/minute

PCFP: ☎️ Restricted operational scope. CCP-A consultation required to establish care plan with clinical advisory group including medical oversight
ACFP: ☎️ CCP-A consultation required

Preparation and Administration

Standard Adult Concentrations

(Single) 16 mcg/mL: dilute 4 mg in 250 mL
(double) 32 mcg/mL: dilute 8 mg in 250 mL
(quad) 64 mcg/mL: dilute 16 mg in 250 mL

Pediatric Standard Concentration:

25 mcg/mL: Add 0.63 mL of 1 mg/mL to 24.37 mL D5W or NS to make 25 mL of 25 mcg/mL
50 mcg/mL: Add 2.5 mL of 1 mg/mL to 47.5 mL D5W or NS to make 50mL of 50 mcg/mL

How Supplied

Vial: 1 mg/mL in 4 mL vial

Mechanism Of Action

Stimulates alpha and beta-1 adrenergic receptors causing increased contractility, heart rate, and vasoconstriction.

Pharmacokinetics

Intravenous:

Onset: immediate
Peak: immediate
Duration: 1-2 minutes after infusion ends

Adverse Effects

Cardiovascular: Hypertension, cardiac arrhythmias
Central nervous system: Anxiety, transient headache, restlessness, tremour

Warning And Precautions

Correct hypovolemia prior to administering norepinephrine.
Vesicant: administer into large vein whenever possible and notify receiving team if extravasation occurs. Monitor catheter and line patency before and during administration.