Norepinephrine Bitartrate (norepinephrine bitartrate)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Norepinephrine bitartrate is an endogenous catecholamine vasopressor that predominantly acts by a direct effect on alpha-adrenergic receptors and to a lesser extent on beta-adrenergic receptors.
Norepinephrine acts predominantly by direct effects on alpha-adrenergic receptors to cause peripheral vasoconstriction and to a lesser extent acts on beta-adrenergic receptors to cause inotropic stimulation of the heart, dilation of coronary arteries, and substantially increased coronary blood flow. Norepinephrine generally does not affect cardiac output, although it can be decreased. Norepinephrine primarily increases systolic, diastolic, and pulse pressures and has minimal effects on chronotropy.
The elevations in resistance and blood pressure cause reflex vagal activity, slowing heart rate and increasing stroke volume. The elevation in vascular tone or resistance reduces blood flow to major abdominal organs and skeletal muscle. The pressor response following IV administration of norepinephrine occurs rapidly and reaches steady state within 5 minutes.
The pharmacologic actions of norepinephrine are terminated primarily by uptake and metabolism in sympathetic nerve endings. The pressor action stops within 1-2 minutes after the infusion is discontinued.
Generic name: norepinephrine bitartrate
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Norepinephrine Bitartrate
Indications
The following indications are listed for Norepinephrine Bitartrate:
- Acute Hypotension
- Severe Hypotension
Also known as: Acutely Decreased Blood Pressure, Severe Arterial Hypotension.
Dosing
Avoid abrupt withdrawal of norepinephrine infusion; discontinue by reducing the flow rate gradually.
Norepinephrine bitartrate is administered by IV infusion. To minimize the risk of necrosis, infusion of the drug should be given into a large vein; avoid infusions into the veins of the leg in elderly patients or in patients with occlusive vascular disease of the legs. Care must be taken to avoid extravasation because local necrosis may result; check the infusion site frequently for free flow and monitor for signs of extravasation.
Visually inspect solutions of norepinephrine for particulate matter and discoloration prior to administration whenever solution and container permit. Do not use the drug if it is discolored (e.g., pink, dark yellow) or contains any particulate matter.
Store norepinephrine bitartrate at 20-25degreesC (excursions permitted to 15-30degreesC) in the original carton until the time of administration and protect from light. Discard any unused portion. Avoid contact of the drug with iron salts, alkalies, or oxidizing agents. Administer whole blood or plasma, if indicated during therapy with norepinephrine, separately.
Norepinephrine bitartrate injection concentrate must be diluted prior to administration; alternatively, commercially available solutions of norepinephrine in 5% dextrose or norepinephrine in 0.9% sodium chloride may be used without dilution.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
*None.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
The most common adverse reactions associated with norepinephrine are ischemic injury, bradycardia, anxiety, transient headache, respiratory difficulty, and extravasation necrosis at injection site.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
No enhanced messaging available.
Safety and effectiveness in pediatric patients have not been established.
Limited data on the use of norepinephrine in pregnant women at the time of delivery have not identified an increased risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. There are risks to the mother and fetus from acute hypotensive states that are medical emergencies in pregnancy (e.g., in septic shock, myocardial infarction, and stroke); these can be fatal if untreated. Delaying necessary treatment may increase the risk of maternal and fetal morbidity and mortality. Life-sustaining therapy for the pregnant woman should not be withheld due to potential concerns regarding the effects of norepinephrine on the fetus.
In animal reproduction studies, high doses of IV norepinephrine resulted in lowered maternal placental blood flow; however, the clinical relevance to changes in the human fetus is unknown. Studies of norepinephrine administration to pregnant animals demonstrated decreases in fetal oxygenation, urine and lung liquid flow, production of cataracts, fetal microscopic liver abnormalities, and delayed skeletal ossification.
There are no data on the presence of norepinephrine in either human or animal milk, the effects on the breastfed infant, or the effects on milk production. Because of its short half-life and poor oral bioavailability, clinically relevant exposure of norepinephrine in the infant is unlikely.
The manufacturer makes no specific dosage recommendations for geriatric patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Clinical studies of norepinephrine bitartrate did not include sufficient numbers of patients 65 years of age and older to determine whether geriatric patients respond differently than younger patients. Clinical experience to date has not identified any differences in responses between geriatric and younger patients. If norepinephrine is used in geriatric patients, dosage should be selected carefully, usually starting at the low end of the dosage range, since renal, hepatic, and cardiovascular dysfunction and concomitant disease or other drug therapy are more common in this age group. Do not infuse into the leg veins of geriatric patients.
ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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