Classes
DEA Class; Rx
Common Brand Names; Levarterenol, Levophed
- Alpha/Beta Adrenergic Agonists
Description
Intravenous catecholamine
Used for restoration of blood pressure in patients with acute hypotensive states
Potent alpha-adrenergic receptor agonist with modest beta-agonist activity
Indications
Indicated for the treatment of acute hypotension, cardiogenic shock, sepsis, or septic shock.
Contraindications
Hypersensitivity
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
Peripheral vascular thrombosis (except for lifesaving procedures)
Concomitant use with some general anesthetics cyclopropane (not available in the US), halothane (not available in the US)
Adverse Effects
- Bradycardia
- Hypertension
- Arrhythmias
- Confusion
- Anxiety
- Dyspnea, with or without respiratory difficulty
- Headache
- Nausea and vomiting
- Sweating
- Tremor
- Restlessness
- Urinary retention
- Extravasation
- Gangrene
Warnings
If therapy is continuously administered to maintain blood pressure in absence of blood volume replacement, severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis may occur
Use extreme caution with concurrent monoamine oxidase inhibitor (MAOI) use or antidepressants of the triptyline or imipramine types; severe, prolonged hypertension may result
Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and seem to sensitize the myocardium to action of intravenously administered epinephrine or norepinephrine
Not for use in profound hypoxia or hypercarbia
Bitartrate 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
Pregnancy and Lactation
Pregnancy category: C
Lactation: Not known if excreted into breast milk; avoid use during breastfeeding
Maximum Dosage
3.3 mcg/kg/minute continuous IV infusion has been used in refractory shock.
3.3 mcg/kg/minute continuous IV infusion has been used in refractory shock.
Safety and efficacy have not been established. Although dosage is titrated to effect, 2 mcg/kg/minute continuous IV infusion is often used as an upper limit.
Safety and efficacy have not been established. Although dosage is titrated to effect, 2 mcg/kg/minute continuous IV infusion is often used as an upper limit.
Safety and efficacy have not been established. Although dosage is titrated to effect, 2 mcg/kg/minute continuous IV infusion is often used as an upper limit.
Safety and efficacy have not been established. Although dosage is titrated to effect, 2 mcg/kg/minute continuous IV infusion is often used as an upper limit.
How supplied
Norepinephrine bitartrate
injectable solution
1mg/mL
