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NorepinephrineAka: Levarterenol, L-norepinephrine

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  1. History
    1. Ulf Von Euler won 1970 Nobel Prize for its discovery
      1. Swedish Chemist also discovered Prostaglandins
  2. Mechanism
    1. Naturally occurring Catecholamine
    2. Beta 1 Adrenergic Receptor Agonist
      1. Similar potency to Epinephrine
      2. Increases myocardial contractility
    3. No Beta 2 Adrenergic Receptor Activity
    4. Potent Alpha Adrenergic Receptor Agonist
      1. Potent arterial and venous vasoconstriction
  3. Indications
    1. Hemodynamically significant hypotension
      1. Refractory to other Sympathomimetic amines
      2. Useful in Low Systemic Vascular Resistance
        1. Septic Shock
        2. Neurogenic Shock
    2. Temporizing measure only
  4. Relative Contraindications
    1. Acute Myocardial Infarction
      1. Use as agent of last resort
  5. Monitoring
    1. Monitor Blood Pressure accurately
      1. Consider Arterial Line with continuous monitoring
      2. Blood Pressure cuff monitoring every 5 minutes
    2. Consider advanced hemodynamic monitoring
      1. Cardiac output
      2. Pulmonary wedge pressure
      3. Peripheral arterial resistance
  6. Precautions
    1. Use as temporizing measure only
    2. Use extreme caution in Myocardial Ischemia
      1. Increases myocardial oxygen requirements
      2. No compensatory increase in coronary perfusion
    3. Observe for arrhythmias
      1. Volume depleted patents
      2. Limited myocardial reserve
    4. Use Norepinephrine only via central venous catheter
      1. Extravasation causes severe local tissue damage
      2. Antidote for extravasation
        1. Phentolamine 5-10 mg diluted in 10-15 ml NS
        2. Infiltrate area of extravasation with Phentolamine
  7. Preparation
    1. Start with Norepinephrine (1 mg/ml) 4 ml ampule
    2. Mix 4 ml Norepinephrine in 250 ml D5W or Normal Saline
    3. Final Concentration: 16 ug/ml Norepinephrine
  8. Dosing: Infusion via Central Venous Catheter
    1. Start: 0.5 to 1.0 ug/min
    2. Titrate to Systolic Blood Pressure over 90 mmHg
      1. Average Adult Dose: 2 to 12 ug/min
      2. Refractory Shock: up to 30 ug/min

Norepinephrine (C0028351)

Definition (MSH)Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic.
Definition (CSP)precursor of epinephrine; widespread central and autonomic neurotransmitter, principal transmitter of most postganglionic sympathetic fibers; secreted by the adrenal medulla; used pharmacologically as a sympathomimetic.
Definition (NCI)A synthetic phenylethylamine that mimics the sympathomimetic actions of the endogenous norepinephrine. Norepinephrine acts directly on the alpha- and beta-adrenergic receptors. Clinically, norepinephrine is used as a peripheral vasoconstrictor that causes constriction of arterial and venous beds via its alpha-adrenergic action. It is also used as a potent inotropic and chronotropic stimulator of the heart mediated through its beta1 adrenergic action.
Definition (NCI)A naturally occurring catecholamine hormone that functions as a neurotransmitter in the sympathetic nervous system. Norepinephrine directly stimulates adrenergic receptors. Stimulation of alpha-adrenergic receptors causes vasoconstriction of the radial smooth muscle of the iris, arteries, arterioles, veins, urinary bladder, and the sphincter of the gastrointestinal tract. Stimulation of beta1-adrenergic receptors causes an increase in myocardial contractility, heart rate, automaticity, and atrioventricular (AV) conduction while stimulation of beta2-adrenergic receptors causes bronchiolar and vascular smooth muscle dilatation.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121) , Neuroreactive Substance or Biogenic Amine (T124)
EnglishArterenol, Levarterenol, Levonorepinephrine, Noradrenalin, Noradrenaline, Noradrenaline preparation, Noradrenaline product, Norepinephrine, NOREPINEPHRINE PREPARATION, Norepinephrine product
Spanishlevarterenol, noradrenalina, norepinefrina, preparado con noradrenalina, preparado con norepinefrina, preparado de noradrenalina, preparado de norepinefrina, producto con noradrenalina
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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