Administration advice: Critical care medicine, no. Previous. 1mcg/min q 5 mins upto 30mcg/min. 1998. Usual dose is 0.03-0.25 μg(mcg)/kg/min. Also review: Beale RJ, Hollenberg SM, Vincent JL, Parrillo JE.Vasopressor and inotropic support in septic shock: an evidence-based review. Adult : IV As norepinephrine base: Initially, 0.4-0.8 mg/hour given via infusion. Initial: 8-12 mcg/min IV infusion; titrate to effect, 0.01-3.3 mcg/kg/min IV infusion (Hollenberg 2009), Should be titrated to age-appropriate blood pressure, Initial: 0.05-0.1 mcg/kg/min IV infusion; titrate to effect, 0.05-0.1 mcg/kg/min IV infusion; titrate to effect; not to exceed 2 mcg/kg/min, Dyspnea, with or without respiratory difficulty, Antidote for extravasation ischemia: To prevent sloughing and necrosis in areas where extravasation has taken place, infiltrate areas promptly with 10-15 mL of saline solution containing 5-10 mg of phentolamine mesylate for injection, Use syringe with fine hypodermic needle, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, pallid appearance, Patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed, Peripheral vascular thrombosis (except for lifesaving procedures), Concomitant use with some general anesthetics cyclopropane (not available in the US), halothane (not available in the US), If therapy is continuously administered to maintain blood pressure in absence of blood volume replacement, severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis may occur, Use extreme caution with concurrent monoamine oxidase inhibitor (MAOI) use or antidepressants of the triptyline or imipramine types; severe, prolonged hypertension may result, Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and seem to sensitize the myocardium to action of intravenously administered epinephrine or norepinephrine, Not for use in profound hypoxia or hypercarbia, Bitartrate injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people, Because of potency of drug and because of varying response to pressor substances, possibility always exists that dangerously high blood pressure may be produced with overdoses of this pressor agent; it is desirable, therefore, to record blood pressure every two min from time administration is started until desired blood pressure is obtained, then every five min if administration is to be continued; rate of flow must be watched constantly, and patient should never be left unattended while receiving therapy; headache may be a symptom of hypertension due to overdosage, When possible, infusions should be given into large vein, particularly an antecubital vein to reduce risk of necrosis of overlying skin from prolonged vasoconstriction; some authors have indicated that femoral vein is an acceptable route of administration; occlusive vascular diseases (for example, atherosclerosis, arteriosclerosis, diabetic endarteritis, Buerger’s disease) are more likely to occur in the lower than in the upper extremity; one should avoid the veins of the leg in elderly patients or in those suffering from such disorders; gangrene has been reported in a lower extremity when infusions were given in an ankle vein, Infusion site should be checked frequently for free flow; care should be taken to avoid extravasation of drug into tissues, as local necrosis might ensue due to vasoconstrictive action of drug; blanching along the course of the infused vein, sometimes without obvious extravasation, has been attributed to vasa vasorum constriction with increased permeability of vein wall, permitting some leakage, Lactation: Not known if excreted into breast milk; avoid use during breastfeeding. Copyright © 1993-2020 Pasin L et al. -Doses given in terms of norepinephrine base. If you log out, you will be required to enter your username and password the next time you visit. Most Strong beta1- and alpha-adrenergic effects and moderate beta2 effects, which increase cardiac output and heart rate, decrease renal perfusion and PVR, and cause variable BP effects, Metabolized by MAO and catechol-O-methyl transferase (COMT) in the adrenergic neuron, Metabolites: Normetanephrine, vanillylmandelic acid (inactive), Not spec: Atropine, carbenicillin, cefazolin, diazepam, Additive: Calcium gluconate, cimetidine, dobutamine, heparin, KCl, verapamil, vitamins B/C, Y-site: Amiodarone, epinephrine, esmolol, fentanyl, furosemide, heparin, hydrocortisone, KCl, vitamins B/C, Solution: 4 mg in 1000 ml D5W (4 mcg/ml); 40 ml/hr (~3 mcg/min); dose may be titrated to patient response, Do not administer NaHCO3 through an IV line containing norepinephrine.


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