Alternate Name(s):
Levophed
Classification:
Sympathomimetic
Original Date:
May 2016
Revised Date:
June 2024
Indications:
- Severe hypotension with poor response to other therapy / Shock
Administration:
- IV continuous infusion
- Central line preferred
Dosage:
- Usual starting dose 0.05 mcg/kg/minute
- Dosing range: 0.01-0.4 mcg/kg/minute
- Max recommended: 1 mcg/kg/minute
- Titration recommendations: titrate by 0.05 mcg/kg/minute to maintain goal BP, Q 15 minutes1
1 meant to be general guidance for titrations, use clinical judgment
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
- Evidence-based Practice for Improving Quality (EPIQ) Recommendations on Hemodynamics, 2023