Norepinephrine Brand Name– Levophed
What is Norepinephrine
Norepinephrine is an intravenous catecholamine indicated for restoration of blood pressure in patients with acute hypotensive states.
It is an endogenous catecholamine synthesized in the adrenal medulla that is the biochemical precursor of epinephrine.
Norepinephrine is the transmitter of most sympathetic postganglionic fibers of the central nervous system.
Norepinephrine is a potent alpha-adrenergic receptor agonist with modest beta-agonist activity.
Administration of norepinephrine to patients who are hypotensive from hypovolemia can result in severe visceral and peripheral vasoconstriction, decreased renal perfusion and reduced urine output, tissue hypoxia, lactic acidosis, and reduced systemic blood flow despite normal blood pressure; therefore, hypovolemia must be corrected before starting norepinephrine.
Gangrene of the extremities has occurred in patients with occlusive or thrombotic vascular disease or who received prolonged or high dose infusions of norepinephrine.
Guidelines recommend norepinephrine as the first-line vasopressor for patients with septic shock
Indications
- cardiogenic shock
- hypotension
- septic shock
For the treatment of acute hypotension, cardiogenic shock, sepsis, or septic shock
Side Effects
- anxiety
- bradycardia
- headache
- hypertension
- hypoxia
- lactic acidosis
- peripheral vasoconstriction
- pulmonary edema
- tissue necrosis
Monitoring Parameters
- blood pressure
- heart rate
Contraindications
- abrupt discontinuation
- asthma
- breast-feeding
- cardiac arrhythmias
- extravasation
- geriatric
- hypovolemia
- hypoxemia
- MAOI therapy
- mesenteric thrombosis
- peripheral vascular disease
- pregnancy
- sulfite hypersensitivity
- thrombosis
Interactions
- Acarbose
- Acebutolol
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Pseudoephedrine
- Aclidinium; Formoterol
- Acrivastine; Pseudoephedrine
- Albiglutide
- Albuterol
- Albuterol; Ipratropium
- Alogliptin; Pioglitazone
- Alpha-blockers
- Alpha-glucosidase Inhibitors
- Ambrisentan
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amoxapine
- Arformoterol
- Articaine; Epinephrine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Atenolol
- Atenolol; Chlorthalidone
- Atomoxetine
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Bendroflumethiazide; Nadolol
- Beta-blockers
- Betaxolol
- Bethanechol
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Bosentan
- Bretylium
- Brimonidine; Timolol
- Bromocriptine
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Budesonide; Formoterol
- Caffeine
- Caffeine; Ergotamine
- Canagliflozin
- Canagliflozin; Metformin
- Carbetapentane; Pseudoephedrine
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Pseudoephedrine
- Cardiac glycosides
- Carteolol
- Carvedilol
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone; Clonidine
- Clomipramine
- Clonidine
- Cocaine
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colchicine
- Colchicine; Probenecid
- COMT inhibitors
- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Desflurane
- Desipramine
- Desloratadine; Pseudoephedrine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Diethylpropion
- Digitoxin
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dihydroergotamine
- Dipeptidyl Peptidase-4 Inhibitors
- Dorzolamide; Timolol
- Doxazosin
- Doxepin
- Dronabinol
- Dulaglutide
- Dyphylline
- Dyphylline; Guaifenesin
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Enflurane
- Entacapone
- Epinephrine
- Epoprostenol
- Ergoloid Mesylates
- Ergonovine
- Ergot alkaloids
- Ergotamine
- Ertugliflozin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Esmolol
- Exenatide
- Fexofenadine; Pseudoephedrine
- Fluphenazine
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol
- Formoterol; Mometasone
- Ginger, Zingiber officinale
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glycopyrrolate; Formoterol
- Green Tea
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Pseudoephedrine
- Guanabenz
- Halogenated Anesthetics
- Halothane
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Ibuprofen; Pseudoephedrine
- Iloprost
- Imipramine
- Incretin Mimetics
- Indacaterol
- Indacaterol; Glycopyrrolate
- Indapamide
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Insulins
- Iobenguane I 131
- Ionic Contrast Media
- Isocarboxazid
- Isoflurane
- Ketamine
- Labetalol
- Levalbuterol
- Levobetaxolol
- Levobunolol
- Levomilnacipran
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Linezolid
- Liothyronine
- Liraglutide
- Lixisenatide
- Loop diuretics
- Loratadine; Pseudoephedrine
- Loxapine
- Macitentan
- Maprotiline
- Mecamylamine
- Meglitinides
- Meperidine; Promethazine
- Mesoridazine
- Metaproterenol
- Metformin; Pioglitazone
- Metformin; Rosiglitazone
- Methohexital
- Methyldopa
- Methylergonovine
- Methylphenidate
- Methysergide
- Metoprolol
- Miglitol
- Milnacipran
- Monoamine oxidase inhibitors
- Nabilone
- Nadolol
- Naproxen; Pseudoephedrine
- Nebivolol
- Nebivolol; Valsartan
- Nicotine
- Nitrates
- Non-Ionic Contrast Media
- Nortriptyline
- Oxytocin
- Ozanimod
- Penbutolol
- Pergolide
- Perphenazine
- Perphenazine; Amitriptyline
- Phendimetrazine
- Phenelzine
- Phenothiazines
- Phenoxybenzamine
- Phentermine
- Phentermine; Topiramate
- Phentolamine
- Phenylephrine; Promethazine
- Pindolol
- Pioglitazone
- Pirbuterol
- Pramlintide
- Prazosin
- Prilocaine; Epinephrine
- Procarbazine
- Prochlorperazine
- Promethazine
- Propofol
- Propranolol
- Protriptyline
- Pseudoephedrine
- Racepinephrine
- Rasagiline
- Riociguat
- Rosiglitazone
- Safinamide
- Salmeterol
- Selegiline
- Selexipag
- Semaglutide
- Sevoflurane
- SGLT2 Inhibitors
- Sibutramine
- Solriamfetol
- Sotalol
- Spironolactone
- St. John’s Wort, Hypericum perforatum
- Sulfonylureas
- Terazosin
- Terbutaline
- Theophylline, Aminophylline
- Thiazide diuretics
- Thiazolidinediones
- Thiethylperazine
- Thiopental
- Thioridazine
- Thiothixene
- Thyroid hormones
- Timolol
- Tolcapone
- Tranylcypromine
- Treprostinil
- Tricyclic antidepressants
- Trifluoperazine
- Trimipramine
- Umeclidinium; Vilanterol
- Vasodilators
- Vasopressin, ADH
- Yohimbine
