Known brand names include Levophed.
A vasopressor given as a slow, continuous IV drip in the hospital to raise dangerously low blood pressure in adults. It tightens blood vessels and strengthens the heartbeat, and if it leaks out of the vein it can kill the nearby tissue.
First-line. Usual first-choice vasopressor for hypotension in septic shock after fluid resuscitation. The label indication is acute hypotension and does not name septic shock.
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Labeled use. Severe, acute hypotension in adults (acute hypotensive states).
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Norepinephrine is the usual first-choice vasopressor for septic shock once fluids have been given, with vasopressin or epinephrine added when pressure stays low. It is generally preferred over dopamine, which causes more arrhythmias. Phenylephrine, a pure alpha agonist, is an option when tachyarrhythmias limit other agents. Short peripheral infusions through a well-placed large vein are common, but a central line is preferred for longer infusions.
A catecholamine with alpha- and beta-adrenergic agonist activity. Alpha stimulation causes peripheral vasoconstriction and raises total peripheral resistance; beta stimulation is inotropic and dilates the coronary arteries. The rise in pressure triggers reflex vagal slowing of the heart and a larger stroke volume, so cardiac output is usually unchanged, though it can fall. Flow to the abdominal organs and skeletal muscle drops, while coronary flow rises substantially. The pressor response is rapid, reaching steady state within 5 minutes; the half-life is about 2.4 minutes, and the pressor effect ends 1 to 2 minutes after the infusion stops.
The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Doses come from the FDA label. Study tool, not for clinical decisions.
No labeled dose change. It can reduce renal perfusion and urine output, especially in hypovolemia. Only small amounts are excreted unchanged; inactive metabolites leave in the urine.
None on the current label. Extravasation and its phentolamine treatment appear under Warnings and Precautions instead.
No reversal agent. Overdose causes headache, severe hypertension, reflex bradycardia, a sharp rise in peripheral resistance, and lower cardiac output; stop the infusion until the patient stabilizes. For extravasation, infiltrate the ischemic area as soon as possible with 5 to 10 mg of phentolamine in 10 to 15 mL of 0.9% sodium chloride through a fine needle; infiltration within 12 hours produces prompt local hyperemia.
Limited data, mostly from use at delivery, have not shown a higher risk of major birth defects, miscarriage, or poor maternal or fetal outcomes. Hypotension from septic shock, heart attack, or stroke in pregnancy can be fatal, so life-sustaining treatment should not be withheld over fetal concerns. High IV doses in animals lowered placental blood flow. It crosses the placenta.
No data on norepinephrine in human or animal milk, on the breastfed infant, or on milk production. Meaningful infant exposure is not expected because of its short half-life and poor oral bioavailability.
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