Cardiovascular Medicine Book



Aka: Norepinephrine, Levarterenol, L-norepinephrine, Levonorepinephrine, Noradrenaline, Levophed
  1. See Also
    1. Epinephrine
    2. Sympathomimetic Toxicity
    3. Sympathetic Nervous System
    4. Sympathomimetic
    5. Alpha Adrenergic Receptor
    6. Beta Adrenergic Receptor
  2. Definitions
    1. Norepinephrine
      1. Natural Catecholamine, released from Adrenal Medulla as a stress response (along with Epinephrine)
      2. Also the primary postganglionic Neurotransmitter of the Sympathetic Nervous System
  3. History
    1. Ulf Von Euler won 1970 Nobel Prize for its discovery
      1. Swedish Chemist also discovered Prostaglandins
  4. Mechanism
    1. Naturally occurring Catecholamine
    2. Potent Alpha Adrenergic Receptor Agonist
      1. Potent arterial and venous Vasoconstriction
    3. Beta 1 Adrenergic Receptor Agonist
      1. Similar potency to Epinephrine
      2. Increases myocardial contractility
    4. No Beta 2 Adrenergic Receptor Activity
  5. Indications
    1. Hemodynamically significant Hypotension
      1. Refractory to other Sympathomimetic amines
      2. Useful in Low Systemic Vascular Resistance
        1. Septic Shock
        2. Neurogenic Shock
    2. Temporizing measure only
  6. Relative Contraindications
    1. Acute Myocardial Infarction
      1. Use as agent of last resort
  7. Monitoring
    1. Monitor Blood Pressure accurately
      1. Consider Arterial Line with continuous monitoring
      2. Blood Pressure cuff monitoring every 5 minutes
    2. Consider advanced hemodynamic monitoring
      1. Cardiac Output
      2. Pulmonary wedge pressure
      3. Peripheral arterial resistance
  8. Precautions
    1. Maximize management of other Hypotension causes first
      1. Maximize fluid Resuscitation in Sepsis
      2. Replace Blood Products in Trauma
    2. Use with caution in Myocardial Ischemia
      1. Increases myocardial oxygen requirements
      2. No compensatory increase in coronary perfusion
    3. Observe for Arrhythmias
      1. Volume depleted patents
      2. Limited myocardial reserve
    4. Norepinephrine is safest to use via central venous catheter
      1. However reliable large bore peripheral IV may be used safely with caution initially (e.g. first 24 hours)
        1. Nguyen (2020) Am J Emerg Med +PMID: 31959524 [PubMed]
      2. Extravasation may cause severe local tissue damage
      3. Antidote for extravasation
        1. Phentolamine 5-10 mg diluted in 10-15 ml NS
        2. Infiltrate area of extravasation with Phentolamine
  9. Preparation
    1. Start with Norepinephrine (1 mg/ml) 4 ml ampule
    2. Mix 4 ml Norepinephrine in 250 ml D5W or Normal Saline
    3. Final Concentration: 16 ug/ml Norepinephrine
  10. Dosing: Infusion via Central Venous Catheter
    1. Weight Based (preferred, adults)
      1. Start at 0.05 mcg/kg/min
      2. Unlikely to benefit from titration above 0.3 mcg/kg/min
    2. Non-weight based
      1. Start at 5 mcg/min (some recommend starting at 0.5 to 1.0 ug/min)
      2. Typical dose range (adults): 2 to 30 mcg/min
    3. Titrate to Systolic Blood Pressure over 90 mmHg
      1. Average Adult Dose: 2 to 12 ug/min
      2. Refractory Shock: up to 30 ug/min
  11. References
    1. McCollum in Herbert (2019) EM:Rap 19(7):4-6

Norepinephrine (C0028351)

Definition (NCI) A naturally occurring catecholamine hormone that functions as a neurotransmitter in the sympathetic nervous system. Norepinephrine directly stimulates adrenergic receptors. Stimulation of alpha-adrenergic receptors causes vasoconstriction of the radial smooth muscle of the iris, arteries, arterioles, veins, urinary bladder, and the sphincter of the gastrointestinal tract. Stimulation of beta-1 adrenergic receptors causes an increase in myocardial contractility, heart rate, automaticity, and atrioventricular (AV) conduction while stimulation of beta-2 adrenergic receptors causes bronchiolar and vascular smooth muscle dilatation.
Definition (NCI_NCI-GLOSS) A chemical made by some nerve cells and in the adrenal gland. It can act as both a neurotransmitter (a chemical messenger used by nerve cells) and a hormone (a chemical that travels in the blood and controls the actions of other cells or organs). Noradrenaline is released from the adrenal gland in response to stress and low blood pressure.
Definition (NCI) A synthetic phenylethylamine that mimics the sympathomimetic actions of the endogenous norepinephrine. Norepinephrine acts directly on the alpha- and beta-adrenergic receptors. Clinically, norepinephrine is used as a peripheral vasoconstrictor that causes constriction of arterial and venous beds via its alpha-adrenergic action. It is also used as a potent inotropic and chronotropic stimulator of the heart mediated through its beta-1 adrenergic action.
Definition (MSH) Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic.
Definition (CSP) precursor of epinephrine; widespread central and autonomic neurotransmitter, principal transmitter of most postganglionic sympathetic fibers; secreted by the adrenal medulla; used pharmacologically as a sympathomimetic.
Concepts Pharmacologic Substance (T121) , Neuroreactive Substance or Biogenic Amine (T124) , Organic Chemical (T109)
MSH D009638
SnomedCT 111130009, 386986004, 349918005, 45555007
LNC LP15271-7, MTHU003447
English Levarterenol, Levonorepinephrine, Noradrenaline, Norepinephrine, norepinephrine, 1,2-Benzenediol, 4-(2-amino-1-hydroxyethyl)-, (R)-, Arterenol, l-Noradrenaline, l-Norepinephrine, levarterenol, Noradrenaline preparation, norepinephrine (medication), vasopressors norepinephrine, noradrenalin, Norepinephrine [Chemical/Ingredient], norepinephrines, noradrenaline, NOREPINEPHRINE, (+/-)-Noradrenaline, l-Arterenol, l-3,4-Dihydroxyphenylethanolamine, (-)-alpha-(aminomethyl)-3,4-dihydroxybenzyl Alcohol, Norepinephrine, DL-, 1,2-benzenediol, 4-(2-amino-1-hydroxyethyl)-, (+/-)-, Noradrenaline product (product), Norepinephrine preparation (substance), (.+-.)-Norepinephrine, NOREPINEPHRINE, DL-, (.+-.)-Noradrenaline, (R)-4-(2-Amino-1-hydroxyethyl)-1,2-benzenediol, Noradrenaline product, Norepinephrine preparation, NA - Noradrenaline, NA - Norepinephrine, Norepinephrine (substance), Norepinephrine preparation (product), Norepinephrine product, Noradrenaline product (substance)
Swedish Noradrenalin
Czech noradrenalin
Finnish Noradrenaliini
French Norépinéphrine, Noradrénaline
Japanese アルテレノール, ノルエピネフリン, レボノルエピネフリン, レバルテレノール, ノルエピネフリン酒石酸塩, 酒石酸水素ノルアドレナリン, 酒石酸ノルアドレナリン, ノルアドレナリン酒石酸塩, ノルアドレナリン塩酸塩, 塩酸ノルアドレナリン, ノルアドレナリン, 酒石酸ノルエピネフリン, 塩酸ノルエピネフリン, 4-(2-アミノ-1-ヒドロキシエチル)-1,2-ベンゼンジオール, 酒石酸水素ノルエピネフリン, ノルエピネフリン塩酸塩
Spanish norepinefrina, norepinefrina (producto), preparado con norepinefrina, producto con noradrenalina (producto), levarterenol, producto con noradrenalina, preparado con noradrenalina, noradrenalina, producto (producto), preparado de noradrenalina (sustancia), preparado de noradrenalina, noradrenalina, producto, noradrenalina (sustancia), noradrenalina, producto (sustancia), noradrenalina, preparado de noradrenalina (producto), preparado de norepinefrina, Norepinefrina, Levarterenol, Levonorepinefrina, Noradrenalina
Polish Norepinefryna, Noradrenalina, Levarterenol, Układ noradrenergiczny
German Levarterenol, Levonorepinephrin, Noradrenalin, Norepinephrin
Italian Norepinefrina
Portuguese Norepinefrina, Levarterenol, Levonorepinefrina, Noradrenalina
Derived from the NIH UMLS (Unified Medical Language System)

Levophed (C0733815)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D009638
English Bitartrate, Levophed, Levophed Bitartrate, levophed, Abbott Brand of Levophed Bitartrate, Levophed
Derived from the NIH UMLS (Unified Medical Language System)

You are currently viewing the original '\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree