Usual Adult Dose for Hypotension

Initial dose: 8 to 12 mcg/min continuous IV infusion
Maintenance dose: 2 to 4 mcg/min continuous IV infusion
Duration of therapy: Continue infusion until adequate blood pressure and tissue perfusion are maintained without therapy.

Comments:

• Doses given in terms of norepinephrine base.
• After observing response to initial dose, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 to 100 mmHg systolic) sufficient to maintain the circulation to vital organs.
• In previously hypertensive patients, blood pressure should be raised no higher than 40 mmHg below the preexisting systolic pressure.
• Doses should be titrated based on individual patient response.
• Infusions should be reduced gradually, avoiding abrupt withdrawal.

Uses: For blood pressure control in certain acute hypotensive cases (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions); and as an adjunct in the treatment of profound hypotension

Usual Adult Dose for Sepsis

Society of Critical Care Medicine recommendations: 0.01 to 3 mcg/kg/min

Use: For use in patients during sepsis or septic shock to increase blood pressure

Usual Adult Dose for Cardiac Arrest

Initial dose: 8 to 12 mcg/min continuous IV infusion
Maintenance dose: 2 to 4 mcg/min continuous IV infusion
Duration of therapy: Continue infusion until adequate blood pressure and tissue perfusion are maintained without therapy.

Comments:

• Doses given in terms of norepinephrine base.
• After observing response to initial dose, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 to 100 mmHg systolic) sufficient to maintain the circulation to vital organs.
• In previously hypertensive patients, blood pressure should be raised no higher than 40 mmHg below the preexisting systolic pressure.
• Doses should be titrated based on individual patient response.
• Infusions should be reduced gradually, avoiding abrupt withdrawal.

Use: As an adjunct in the treatment of cardiac arrest

American Heart Association recommendations: 0.1 to 0.5 mcg/kg/min IV infusion; titrate to effect

Comments:

• A 70 kg adult patient would receive a dose from 7 to 35 mcg/min.

Use: For use in the treatment of post cardiac arrest care for severe hypotension (e.g., systolic blood pressure less than 70 mmHg) and a low total peripheral resistance

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Elderly: Initiate at the low end of the dosing range due to increased likelihood for decreased hepatic, renal, or cardiac function or presence of concomitant diseases or other drug therapy. Avoid administration into veins of the leg.

High dosage: Vast individual variation occurs in the dose required to attain and maintain an adequate blood pressure. In all cases, doses should be titrated based on individual patient response. Occasionally, much larger doses (as high as 68 mg base) may be needed if the patient remains hypotensive, however, blood volume depletion should always be suspected and corrected when present; monitoring of central venous pressure may be helpful in detecting and treating this situation.

Precautions

US BOXED WARNING: ANTIDOTE FOR EXTRAVASATION ISCHEMIA:

• To prevent sloughing and necrosis in areas in which extravasation has taken place, the area should be infiltrated as soon as possible with 10 to 15 mL of saline solution containing from 5 to 10 mg of phentolamine, an adrenergic blocking agent. A syringe with a fine hypodermic needle should be used, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, and pallid appearance. Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours; therefore, phentolamine should be given as soon as possible after the extravasation is noted.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• For IV infusion only.
• Infusions should be given into a large vein.
• The manufacturer product information should be consulted.

Storage requirements:

• Protect from light.
• Avoid contact with iron salts, alkalis, or oxidizing agents.

Reconstitution/preparation techniques:

• Should be diluted in 5% dextrose injection or 5% dextrose and sodium chloride injections. -Administration in saline solution alone not recommended.
• Whole blood or plasma, if indicated to increase blood volume, should be administered separately.
• The manufacturer product information should be consulted.

General:

• Blood volume depletion should always be corrected as fully as possible before administration.
• In an emergency measure, if intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, this drug can be administered before and concurrently with blood volume replacement.

Monitoring:

• Cardiovascular: Measure blood pressure every 2 minutes from the start of administration until desired blood pressure is achieved, then every 5 minutes if administration is continued.

Frequently asked questions

• Norepinephrine vs epinephrine: what's the difference?
• Strattera vs Adderall: What is the difference?
• What are some common side effects of antidepressants?