Parenteral Manual

Norepinephrine bitartrate

Disclaimer: Official controlled document is the CHEO 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): 
NORADRENALIN BITARTRATE, LEVARTERENOL BITARTRATE, NOREPINEPHRINE, LEVOPHED®
Classification: 
Sympathomimetic
Original Date: 
August 2005
Revised Date: 
November 2024
Indications: 
  • Maintenance and restoration of blood pressure in acute hypotensive states
  • Main effects are vasoconstriction and cardiac stimulation
Reconstitution and Stability: 
  • Protect from light. Stable at room temperature
  • DO NOT use if brown in colour or contains a precipitate
  • Diluted solutions stable 24 hours at room temperature in D5W and NS (less stable in NS)

Norepinephrine 12 mcg/mL: 

  • Draw up 0.6 mg (0.6 mL) of norepinephrine 1 mg/mL and add to 49.4 mL of NS 

Norepinephrine 50 mcg/mL (central line only):

  • Draw up 2.5 mg (2.5 mL) of norepinephrine 1 mg/mL and add to 47.5 mL of NS 

Norepinephrine 200 mcg/mL (central line only): 

  • Draw up 10 mg (10 mL) of norepinephrine 1 mg/mL and add to 40 mL of NS 
Compatibility: 

- Solutions Compatible: D5W, D5W/0.9 NaCl, 0.9%NaCl (D5W or D5W/0.9% NaCl recommended because the dextrose protects against loss of potency due to oxidation), ringer's lactate, ringer's solution

- Additive/Above CassetteCompatible: ciprofloxacin

- Y-site Compatible: cisatracurium, dobutamine, dopamine, epinephrine, esmolol, fentanyl, furosemide, heparin, hydromorphone, labetalol, magnesium sulfate, meropenem, midazolam, milrinone, morphine, nitroglycerin, nitroprusside sodium, propofol, KCl (up to 40 mmol/L), ranitidine, SMOF Lipid 20%,  TPN (amino acids/dextrose), vecuronium

- Incompatible: alkaline solutions (eg. aminophylline, sodium bicarbonate, barbiturates, phenytoin, pentobarbital, phenobarbital, lidocaine), oxidizing agents, whole blood, thiopental, insulin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO
IV Intermittent Infusion

NO
IV Continuous Infusion

Yes, cardiac monitoring, continuous BP monitoring
Administer into large vein to avoid potential extravasation

Standard concentrations in ER/OR/PICU: 12 mcg/mL, 
                                                           Central line only: 50 mcg/mL , 200 mcg/mL

Click here to access SDC Drug Infusion Sheet

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Dose stated in terms of norepinephrine base.

Pediatric:

  • Initial: 0.01-0.1 mcg/kg/minute IV, titrate to desired effect
  • Usual maintenance: 0.01-1 mcg/kg/minute
  • Maximum dose: 2 mcg/kg/minute

Adolescent/Adult:

  • Initiate at 4 mcg/minute IV (range: 8-12 mcg/minute)
  • Usual maintenance: 2-4 mcg/minute IV
Potential hazards of parenteral administration: 
  • Bradycardia (Antidote: atropine), tachycardia, premature ventricular contractions, chest pains
  • Headache, restlessness, anxiety, insomnia
  • Hypersensitivity reactions (Injection contains metabisulfite that may cause an allergic reaction in susceptible individuals)
  • Avoid extravasation as it may cause sloughing and necrosis (Treatment: phentolamine). If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.  
Notes: 
  • Check blood pressure every 2 minutes until desired level, then every 5 minutes.  DO NOT leave patient unattended.  DO NOT discontinue abruptly because of danger of sudden drop in blood pressure.
  • 1 mL solution = 2 mg norepinephirne bitartrate = 1 mg norepinephrine base
  • Monitor BP, HR, urine output, peripheral perfusion

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