Section 13 · Monograph
Norepinephrine
Reviewed Nov 2026FDA label
LevophedVasopressor
- Forms
- IV: 1mg/mL vial (4mg/4mL); premixed bags
- Dose
- Start 0.05-0.2mcg/kg/min via central line, titrate to MAP/CPP goal; neurogenic shock or spinal cord injury MAP augmentation per protocol
- MOA
- α1 and β1 adrenergic agonism
Indications
- Blood pressure control in acute hypotensive states (e.g., septic or neurogenic shock)FDA-labeled
Off-Label Uses
- Spinal cord injury: MAP augmentation (commonly 85-90mmHg for up to 7 days)Off-label
- CPP maintenance in raised ICP; BP support in SAH vasospasm per protocolOff-label
Mechanism of Action
- Endogenous catecholamine with potent alpha-1 and beta-1 adrenergic agonism, producing vasoconstriction and modest inotropy
Full Dosing
Adult / usual
- Start about 0.05-0.2mcg/kg/min via central line; titrate to MAP or CPP goal
- Doses up to about 3mcg/kg/min have been used in refractory shock
- Correct hypovolemia first; wean gradually
Contraindications
- Hypotension due to blood volume deficit except as an emergency measure until volume is replaced
- Mesenteric or peripheral vascular thrombosis (relative)
- Hypersensitivity (including sulfite sensitivity with some products)
Drug Interactions
- MAOIs and tricyclic antidepressants potentiate pressor effects
- Halogenated anesthetics sensitize the myocardium to arrhythmias
- Oxytocic drugs may cause severe hypertension
Adverse Effects
- Arrhythmias and bradycardia (reflex)
- Severe hypertension
- Extravasation with tissue necrosis (phentolamine infiltration is the antidote)
- Peripheral and visceral ischemia
Monitoring Parameters
- Continuous arterial blood pressure
- Infusion site and perfusion (digits, urine output, lactate)
- ECG
Pregnancy & Lactation
- Limited data; may reduce uterine blood flow — use if benefit justifies risk
- Unknown whether present in milk