Noradrenaline

ADMINISTRATION ROUTES:

IV

ALTERNATIVE NAMES:

Levophed, norepinephrine

ICU INDICATIONS:

1. Septic shock
2. Other distributive shock

PRESENTATION AND ADMINISTRATION:

Use 10 mg in 100 mL (0.1 mg/mL) pre-mixed bags

2 mg in 2 mL vials (1:1000) can be used to make up double strength noradrenaline if required by adding 20 mg of noradrenaline to 100 mL of compatible IV fluid

Compatible with the following IV fluids: 5% dextrose, dextrose with sodium chloride

Store at room temperature

DOSAGE:

IV:

0 - 20 mL/hr (higher doses may be required)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

No dosage adjustment is required

DOSAGE IN PAEDIATRICS:

IV Infusion:

0.3 mg/kg in 50 mL 5% dextrose at 0.5 - 10 mL/hr (equates to 0.05 - 1 mcg/kg/min)

CLINICAL PHARMACOLOGY:

Noradrenaline bitartrate functions as a peripheral vasoconstrictor (alpha-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries (beta- adrenergic action). The alpha action predominates

CONTRAINDICATIONS:

Nil

WARNINGS:

Noradrenaline injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people

Noradrenaline should be used with caution in patients receiving monoamine oxidase inhibitors (MAOIs) or triptyline/imipramine antidepressants as severe prolonged hypertension may result

Noradrenaline should be given via a central line whenever possible due to the risk of necrosis of overlying skin from extravasation. It may be given by a large bore peripheral cannula in a large vein (antecubital or femoral) in an emergency situation until central venous access has been established. If extravasation occurs, the area should be injected with 5 - 10 mg of phentolamine diluted in 10 - 15 mL of 0.9% saline. Administer through a fine hypodermic needle into the affected area as soon as possible

PRECAUTIONS:

General:

Noradrenaline should not be given to patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed

Laboratory Tests:

No tests additional to routine ICU tests are required

Drug/Laboratory Test Interactions:

None reported

IMPORTANT DRUG INTERACTIONS IN ICU:

None of note

ADVERSE REACTIONS:

Body as a Whole:

Ischaemic injury due to potent vasoconstrictor action tissue hypoxia

Cardiovascular System:

Bradycardia, probably as a reflex result of a rise in blood pressure. Also arrhythmias (including ventricular tachycardia, atrial fibrillation, ventricular fibrillation) which may be exacerbated in the setting of hypoxaemia or hypercarbia

Nervous System:

Anxiety, transient headache