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NORepinephrine

Classification

High Alert Medication
Sympathomimetic

Indications

PCFP/ACFP/CCP: Shock and hypotension following adequate volume replacement

ACP Pilot: Shock and hypotension following adequate volume replacement for age 12 and over

Contraindications

Pheochromocytoma

Adult dosages

CCP: All indications

ACP Pilot: All indications

Infusion

Initial: 5 mcg/min; Usual range: 2 - 40 mcg/min, (max 80mcg/min)
- Titrate every 5 - 15 minutes to achieve target MAP greater than 65mmhg

Pediatric Considerations And Dosing

Follow weight-based dosing

CCP: All indications

ACP Pilot: All indications for patients age 12 and older

Infusion

Initial: 0.1 mcg/kg/minute IV/IO; Usual range: 0.02 - 0.4 mcg/kg/min, (maximum 1 mcg/kg/min)

Interfacility Transport

ADULT:

PCFP: All indications

Infusion

Initial: 5 mcg/min; Usual range: 2 - 40 mcg/min, (max 80mcg/min)
- Titrate every 5 - 15 minutes to achieve target MAP greater than 65mmhg

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

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PEDIATRIC:

Infusion

PCFP: All Indications

Initial: 0.1 mcg/kg/minute IV/IO; Usual range: 0.02 - 0.4 mcg/kg/min, (maximum 1 mcg/kg/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

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 1.25 mL of 1 mg/mL to 50mL of NS
50 mcg/mL: Add 2.5 mL of 1 mg/mL to 50mL of NS

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.

Pharmocokinetics

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.

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Licence Level Filtering

NORepinephrine

Classification

Indications

Contraindications

Adult dosages

Pediatric Considerations And Dosing

Interfacility Transport

Preparation And Administration

How Supplied

Mechanism Of Action

Pharmocokinetics

Adverse Effects

Warning And Precautions