NOREPINEPHRINE BITARTRATE (LEVOPHED®)

CLASS:

• Adrenergic agonist and inotrope

• Catecholamine

ACTIONS:

• Increases systemic vascular resistance through alpha adrenergic stimulation (vasoconstriction)

• B1 effects like epinephrine

INDICATION:

• Hypotension due to a low total peripheral resistance as in septic and neurogenic shock

• Hypotension unresponsive to fluid volume replacement

• Refractory hypotension in tricyclic antidepressant overdose not responsive to sodium bicarbonate

CONTRAINDICATION:

• Hypovolemic patients

• Pheochromocytoma

• Patients taking MAOI’s

STANDARD PREP:

• 4 mg / 4 ml ampule

• 4 mg norepinephrine in 250 cc NS resulting in a concentration of 16 ug / cc

DOSE/ROUTE:

• ACLS - initial dose of 0.1 - 0.5 ug / kg / min titrated to effect

SIDE EFFECTS:

• Dysrhythmias

• Chest pain

• Hypertension

• Intracerebral hemorrhage

• Headache

• Restlessness / tremors

• Increased myocardial oxygen demand

• Necrosis, tissue sloughing with extravasation

PRECAUTIONS:

• Beta blockers - will block beta effects of norepinephrine, allow unopposed alpha effects

• Digoxin - increases risk of arrhythmia

• Do not administer in the same line as alkaline IV solutions

• Norepinephrine causes renal and mesenteric vasoconstriction even at low doses

• Extravasation and tissue sloughing if extravasation occurs. Inform ER RN or MD since regitine required if infiltration occured.