General MedicationsINTRAVENOUSHigh Alert

Norepinephrine

NOREPINEPHRINE BITARTRATE

Standard Dose

2 DOSAGE AND ADMINISTRATION No further dilution prior to infusion is required ( 2.1 ) Initial intravenous infusion rate of 8 to 12 mcg per minute, adjust the rate of flow to establish and maintain a low to normal blood pressure (usually 80 to 100 mm Hg) sufficient to maintain the circulation of vital organs ( 2.2 ) The average maintenance dose ranges from 2 to 4 mcg per minute. ( 2.2 ) 2.1 Important Dosage and Administration Instructions Correct Hypovolemia Address hypovolemia before initiation of Norepinephrine in Sodium Chloride Injection therapy. If the patient does not respond to therapy, suspect occult hypovolemia [see Warnings and Precautions ( 5.1 )] . Administration Infuse Norepinephrine in Sodium Chloride Injection into a large vein. Avoid infusions into the veins of the leg in the elderly or in patients with occlusive vascular disease of the legs [see Warnings and Precautions ( 5.1 )] . Avoid using a catheter-tie-in technique. Inspect parenteral drug products for particulate matter and discoloration prior to use, whenever solution and container permit. Do not open the aluminum foil pouch until time of use. The premixed, ready-to-use infusion bag has a single port for insertion of the infusion set only. Do not use this port to remove content from the bag or add another medication. Once the infusion bag has been connected to the infusion set, it is stable for 24 hours for intermittent or continuous use, as long as the bag stays connected to the infusion set. Discontinuation When discontinuing the infusion, reduce the flow rate gradually. Avoid abrupt withdrawal. Single dose only. Discard unused portion. 2.2 Dosage After an initial dose of 8 to 12 mcg per minute via intravenous infusion, assess patient response and adjust dosage to maintain desired hemodynamic effect. Monitor blood pressure every two minutes or continuously until the desired hemodynamic effect is achieved, and then monitor blood pressure every five minutes for the duration of the infusion. Recommended Average Maintenance Dosage: Typical maintenance intravenous dosage is 2 to 4 mcg per minute. 2.3 Drug Incompatibilities Avoid contact with iron salts and alkalizing and oxidizing agents. Whole blood or plasma, if indicated to increase blood volume, should be administered separately.

Max Dose

See official label

Primary Use

1 INDICATIONS AND USAGE Norepinephrine in Sodium Chloride Injection is indicated to raise blood pressure in adult patients with severe, acute hypotension.

Summary

Indications and usage 1 INDICATIONS AND USAGE Norepinephrine in Sodium Chloride Injection is indicated to raise blood pressure in adult patients with severe, acute hypotension.

Norepinephrine in Sodium Chloride Injection is a catecholamine indicated for restoration of blood pressure in adult patients with acute hypotensive states. ( 1 ) Dosage and administration 2 DOSAGE AND ADMINISTRATION No further dilution prior to infusion is required ( 2.1 ) Initial intravenous infusion rate of 8 to 12 mcg per minute, adjust the rate of flow to establish and maintain a low to normal blood pressure (usually 80 to 100 mm Hg) sufficient to maintain the circulation of vital organs ( 2.2 ) The average maintenance dose ranges from 2 to 4 mcg per minute. ( 2.2 ) 2.1 Important Dosage and Administration Instructions Correct Hypovolemia Address hypovolemia before initiation of Norepinephrine in Sodium Chloride Injection therapy.

Structured Monograph

Clinical summary

Indications and usage 1 INDICATIONS AND USAGE Norepinephrine in Sodium Chloride Injection is indicated to raise blood pressure in adult patients with severe, acute hypotension. Norepinephrine in Sodium Chloride Injection is a catecholamine indicated for restoration of blood pressure in adult patients with acute hypotensive states. ( 1 ) Dosage and administration 2 DOSAGE AND ADMINISTRATION No further dilution prior to infusion is required ( 2.1 ) Initial intravenous infusion rate of 8 to 12 mcg per minute, adjust the rate of flow to establish and maintain a low to normal blood pressure (usually 80 to 100 mm Hg) sufficient to maintain the circulation of vital organs ( 2.2 ) The average maintenance dose ranges from 2 to 4 mcg per minute. ( 2.2 ) 2.1 Important Dosage and Administration Instructions Correct Hypovolemia Address hypovolemia before initiation of Norepinephrine in Sodium Chloride Injection therapy. If the patient does not respond to therapy, suspect occult hypovolemia [see Warnings and Precautions ( 5.1 )] . Administration Infuse Norepinephrine in Sodium Chloride Injection into a large vein. Avoid infusions into the veins of the leg in the elderly or in patients with occlusive vascular disease of the legs [see Warnings and Precautions ( 5.1 )] . Avoid using a catheter-tie-in technique. Inspect parenteral drug products for particulate matter and discoloration prior to use, whenever solution and container permit. Do not open the aluminum foil pouch until time of use. The premixed, ready-to-use infusion bag has a single port for insertion of the infusion set only. Do not use this port to remove content from the bag or add another medication. Once the infusion bag has been connected to the infusion set, it is stable for 24 hours for intermittent or continuous use, as long as the bag stays connected to the infusion set. Discontinuation When discontinuing the infusion, reduce the flow rate gradually. Avoid abrupt withdrawal. Single dose only. Discard unused portion. 2.2 Dosage After an initial dose of 8 to 12 mcg per minute via intravenous infusion, assess patient response and adjust dosage to maintain desired hemodynamic effect. Monitor blood pressure every two minutes or continuously until the desired hemodynamic effect is achieved, and then monitor blood pressure every five minutes for the duration of the infusion. Recommended Average Maintenance Dosage: Typical maintenance intravenous dosage is 2 to 4 mcg per minute. 2.3 Drug Incompatibilities Avoid contact with iron salts and alkalizing and oxidizing agents. Whole blood or plasma, if indicated to increase blood volume, should be administered separately. Warnings and cautions 5 WARNINGS AND PRECAUTIONS Tissue Ischemia : Avoid extravasation into tissues, which can cause local necrosis ( 5.1 ) Hypotension After Abrupt Discontinuation : Sudden cessation of the infusion rate may result in marked hypotension. Reduce the Norepinephrine in Sodium Chloride Injection infusion rate gradually. ( 5.2 ) Cardiac Arrhythmias : Norepinephrine in Sodium Chloride Injection may cause arrhythmias. Monitor cardiac function in patients with underlying heart disease. ( 5.3 ) 5.1 Tissue Ischemia Administration of Norepinephrine in Sodium Chloride Injection to patients who are hypotensive from hypovolemia can result in severe peripheral and visceral vasoconstriction, decreased renal perfusion and reduced urine output, tissue hypoxia, lactic acidosis, and reduced systemic blood flow despite “normal” blood pressure. Address hypovolemia prior to initiating Norepinephrine in Sodium Chloride Injection [see Dosage and Administration ( 2.1 )] . Avoid Norepinephrine in Sodium Chloride Injection in patients with mesenteric or peripheral vascular thrombosis, as this may increase ischemia and extend the area of infarction. Gangrene of the extremities has occurred in patients with occlusive or thrombotic vascular disease or who received prolonged or high dose infusions. Monitor for changes to the skin of the extremities in susceptible patients. Extravasation of Norepinephrine in Sodium Chloride Injection may cause necrosis and sloughing of surrounding tissue. To reduce the risk of extravasation, infuse into a large vein, check the infusion site frequently for free flow, and monitor for signs of extravasation [see Dosage and Administration ( 2.1 )] . Emergency Treatment of Extravasation To prevent sloughing and necrosis in areas in which extravasation has occurred, infiltrate the ischemic area as soon as possible, using a syringe with a fine hypodermic needle with 5 to 10 mg of phentolamine mesylate in 10 mL to 15 mL of 0.9% Sodium Chloride Injection in adults. Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours. 5.2 Hypotension after Abrupt Discontinuation Sudden cessation of the infusion rate may result in marked hypotension. When discontinuing the infusion, gradually reduce the Norepinephrine in S

Monitoring

• 5 WARNINGS AND PRECAUTIONS Tissue Ischemia : Avoid extravasation into tissues, which can cause local necrosis ( 5.1 ) Hypotension After Abrupt Discontinuation : Sudden cessation of the infusion rate may result in marked hypotension.
• Reduce the Norepinephrine in Sodium Chloride Injection infusion rate gradually.
• ( 5.2 ) Cardiac Arrhythmias : Norepinephrine in Sodium Chloride Injection may cause arrhythmias.
• Monitor cardiac function in patients with underlying heart disease.

Interaction Notes

• 7 DRUG INTERACTIONS Monoamine oxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine types may result in hypertension.
• ( 7.1 ) Cyclopropane and halothane anesthetics increase cardiac autonomic irritability.
• ( 7.4 ) 7.1 MAO-Inhibiting Drugs Co-administration of Norepinephrine in Sodium Chloride Injection with monoamine oxidase (MAO) inhibitors or other drugs with MAO-inhibiting properties (e.g., linezolid) can cause severe, prolonged hypertension.
• If administration of Norepinephrine in Sodium Chloride Injection cannot be avoided in patients who recently have received any of these drugs and in whom, after discontinuation, MAO activity has not yet sufficiently recovered, monitor for hypertension.