norepinephrine
Indication
- Treatment of severe hypotension after adequate fluid volume replacement, warm shock and/or vasodilatory shock
- Mainly stimulates alpha-adrenergic receptors causing, vasoconstriction
Dosage Guidelines
- Initial dose: 0.05-0.15 microgram/kg/min IV continuous infusion. Titrate to desired blood pressure as per MD/NP order every 15 to 30 minutes
- Maximum dose: 0.2 microgram/kg/min. Escalation beyond this dose would need echocardiographic guidance/MRP order
Administration
- IV continuous infusion
- For patients 1 kg or less:
Use norepinephrine 8 microgram/mL
To make 50 mL of norepinephrine [8 microgram/mL] [0.4 mg/50mL]:
Add 0.4 mL (0.4 mg) of norepinephrine [1 mg/mL] to 49.6 mL of solution
- For patients over 1 kg to 3 kg:
Use norepinephrine 16 microgram/mL
To make 50 mL of norepinephrine [16 microgram/mL] [0.8 mg/50 mL]:
Add 0.8 mL (0.8 mg) of norepinephrine [1 mg/mL] to 49.2 mL of solution
- For patients over 3 kg:
Use norepinephrine 32 microgram/mL
To make 50 mL of norepinephrine [32 microgram/mL] [1.6 mg/50 mL]:
Add 1.6 mL (1.6 mg) of norepinephrine [1 mg/mL] to 48.4 mL of solution
- Administer via central line whenever possible
Adverse Effects
- Cardiac arrythmias, bradycardia, peripheral (digital) ischemia
- Skin necrosis with extravasation
Comments
- Hypovolemia should be corrected prior to use
- Alpha effects (vasoconstriction) are significantly greater than beta effects (inotropic and chronotropic effects) which are mild.
- If ventricular contractility is impaired caution should be exercised as excessive vasoconstriction will result in increased afterload.
- Norepinephrine may cause pulmonary vasodilatation particularly in neonates with preexisting increase in basal pulmonary vascular tone.
- Monitor blood pressure, heart rate, ECG, urine output, peripheral perfusion
- Monitor IV site routinely for extravasation
- If extravasation occurs, consider the use of phentolamine
- Protect from light
Supplied As
- 1 mg/mL, 4 mL vial
- Supplied by Pharmacy as standard concentrations:
- 1 kg or less: 8 mcg/mL, supplied as 0.4 mg in 50 mL IV solution
- Over 1 kg to 3 kg: 16 mcg/mL, supplied as 0.8 mg in 50 mL IV solution
- Over 3 kg: 32 mcg/mL, supplied as 1.6 mg in 50 mL IV solution
- At LHSC, standard concentration reference charts are available on the NICU Intranet site
References
Lexi Sick Kids and Lexi Pediatric and Neonatal