Generic Name

Norepinephrine Bitartrate

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Classification

FDA Approved Indications

• Treatment of profound hypotension including shock, septic shock, and other forms of distributive shock

Mechanism of Action

Stimulates alpha-adrenergic receptors causing vasoconstriction, increases blood pressure; also stimulates beta-adrenergic receptors leading to increased cardiac output.

Dosage and Administration

Adult: Initial infusion rate: 8-12 mcg/min IV infusion, titrated to desired blood pressure; typical maintenance doses range from 2-30 mcg/min.

Pediatric: Dosage varies based on weight and clinical response. Starting doses often similar to adults, titrated carefully.

Geriatric: Use with caution; start at lower end of dosing range, monitor hemodynamics closely.

Renal Impairment: Adjustments generally not required, but caution advised due to altered pharmacokinetics.

Hepatic Impairment: Limited data; use cautiously.

Pharmacokinetics

Absorption: Not applicable; administered intravenously.

Distribution: Widely distributed in body tissues; crosses the placenta.

Metabolism: Metabolized primarily in the liver and other tissues by catechol-O-methyltransferase and monoamine oxidase.

Excretion: Metabolites excreted in urine.

Half Life: Approximately 2.5 minutes due to rapid metabolism.

Contraindications

• Hypersensitivity to norepinephrine or other components

Precautions

• Severe peripheral vascular disease, myocardial ischemia, or during extravasation at infusion site (may cause tissue necrosis)
• Use with caution in patients with tachyarrhythmias, hypertension, or pre-existing coronary artery disease.

Adverse Reactions - Common

• Hypertension (Common)
• Arrhythmias (Common)
• Palpitations (Less common)

Adverse Reactions - Serious

• Myocardial ischemia/necrosis (Rare)
• Extravasation leading to tissue necrosis (Rare)

Drug-Drug Interactions

• Other vasopressors, monoamine oxidase inhibitors (MAOIs),TCAs which may potentiate effects

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report any pain, pallor, or coldness at infusion site immediately.
• Ensure understanding of the purpose of medication and importance of monitoring during therapy.

Special Considerations

Black Box Warnings:

• Extravasation can cause tissue necrosis; appropriate infusion technique required.

Genetic Factors: None well-defined.

Lab Test Interference: May affect blood pressure and cardiac monitoring, but no significant laboratory test interference.

Overdose Management

Signs/Symptoms: Severe hypertension, arrhythmias, myocardial ischemia, tissue necrosis at infusion site.

Treatment: Discontinue norepinephrine, provide supportive care, administer alpha-adrenergic antagonists such as phentolamine for extravasation, manage cardiovascular stability as needed.

Storage and Handling

Storage: Store at controlled room temperature (20°C to 25°C, 68°F to 77°F). Protect from light and freezing.

Stability: Stable for up to 24 months when stored properly; stability may vary based on preparation and diluent.