Norepinephrine

Provider Level

RN/Paramedic

Class

Sympathomimetic, Vasopressor

Mechanism of Action

Potent alpha-1 and beta-1 adrenergic receptor agonist that produces profound vasoconstriction and positive inotropic effects, leading to increased systemic vascular resistance and blood pressure.

Indications

Severe hypotension, cardiogenic shock, neurogenic shock, septic shock unresponsive to fluid resuscitation.

Contraindications

Hypovolemia without adequate fluid resuscitation, mesenteric or peripheral vascular thrombosis.

Routes

IV, IO

Onset / Duration

Onset: 1 to 3 minutes. Duration: 1 to 2 minutes after infusion is discontinued.

Adverse Effects

Arrhythmias, tachycardia, reflex bradycardia, hypertension, tissue necrosis with extravasation, anxiety, headache, peripheral ischemia.

Precautions & Interactions

Ensure adequate fluid resuscitation prior to administration. Monitor blood pressure and cardiac rhythm continuously. Monitor IV site closely for extravasation.

Special Considerations

Administer via large peripheral vein or central line if available. Phentolamine is the specific antidote for tissue necrosis caused by extravasation. Do not mix with alkaline solutions.