Neonatal Drug Therapy Manual

Norepinephrine

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Levophed
Classification: 
Sympathomimetic
Original Date: 
May 2016
Indications: 
  • Severe hypotension with poor response to other therapy / Shock
Administration: 
  • IV continuous infusion
    • Central line preferred
Dosage: 
  • Initial: 0.01 - 0.1 mcg/kg/min, titrate to a maximum dose of 2 mcg/kg/min
Side Effects: 
  • CVS: arrhythmias, bradycardia, peripheral (digital) ischemia
  • Local: skin necrosis with extravasation
Parameters to Monitor: 
  • BP, HR
  • ECG
  • Peripheral perfusion
  • Site of injection
Reconstitution and Stability: 
  • Norepinephrine 1 mg/mL
    • Take 0.24 mL (0.24 mg) and add to 19.76 mL of D5W
    • Final concentration: 12 mcg/mL
  • Norepinephrine 1 mg/mL
    • Take 1 mL (1 mg) and add to 19 mL of D5W
    • Final concentration: 50 mcg/mL (central line only)
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, D5W/0.9%NaCl

- Y-site Compatible: dobutamine, dopamine, epinephrine, fentanyl, KCl (up to 40 mmol/L), furosemide, heparin, hydromorphone, meropenem, midazolam, milrinone, morphine, SMOF, TPN

- Incompatible: insulin, pantoprazole, sodium bicarbonate

References: 

- Lau E (Editor). Drug Handbook and Formulary - The Hospital for Sick Children.  Toronto; 2016

- Taketomo CK,Hodding JH, Kraus DM.  Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015

 

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