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Norepinephrine (noradrenaline): Drug information

Norepinephrine (noradrenaline): Drug information
(For additional information see "Norepinephrine (noradrenaline): Patient drug information" and see "Norepinephrine (noradrenaline): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Levophed
Brand Names: Canada
  • Levophed
Pharmacologic Category
  • Alpha-/Beta- Agonist
Dosing: Adult
Cardiogenic shock

Cardiogenic shock:

Note: Optimal goal of therapy not well established, but typically titrate to maintain end-organ perfusion. Institutional protocols may vary with weight-based or non-weight-based dose regimens (AHA [van Diepen 2017]; Hochman 2020).

Continuous infusion:

Weight-based dosing: IV: Initial: 0.05 mcg/kg/minute; titrate based on clinical end point (eg, BP, end-organ perfusion); usual dosage range: 0.05 to 0.4 mcg/kg/minute (AHA [van Diepen 2017]; Levy 2018).

Non–weight-based dosing (based on ~80 kg patient): IV: Initial: 5 mcg/minute; titrate based on clinical end point (eg, BP, end-organ perfusion); usual dosage range: 5 to 30 mcg/minute (doses calculated and rounded for an 80 kg patient based on weight-based dosing using the referenced sources (AHA [van Diepen 2017]; Levy 2018).

Hepatorenal syndrome type 1 or acute kidney injury, treatment

Hepatorenal syndrome type 1 or acute kidney injury, treatment (alternative agent) (off-label use): Note: Alternative to terlipressin (not available in the United States or Canada). Use in combination with albumin (AASLD [Biggins 2021]).

Continuous infusion :

Non–weight-based dosing: IV: Initial: 5 to 8 mcg/minute; dose may be increased every 4 hours based on clinical end points (eg, increase mean arterial pressure of ~10 mm Hg from baseline, improved urine output); maximum dose: 10 mcg/minute non-ICU; 50 mcg/minute in ICU (AASLD [Biggins 2021]; Duvoux 2002; El-Desoki Mahmoud EI 2021; Kwong 2021; Sharma 2008; Singh 2012).

Post–cardiac arrest shock

Post–cardiac arrest shock:

Note: Optimal goal of therapy not well established, but typically titrate to mean arterial BP (MAP) >65 mm Hg and preferably systolic BP of 80 to 100 mm Hg to optimize cerebral and end-organ perfusion. Institutional protocols may vary with weight-based or non-weight-based dose regimens (AHA [Callaway 2015]; Elmer 2021).

Continuous infusion:

Weight-based dosing: IV: Initial: 0.05 to 0.15 mcg/kg/minute; titrate based on clinical end points (eg, MAP, end-organ perfusion); usual dosing range: 0.05 to 1 mcg/kg/minute; maximum dose range for refractory shock: 1 to 3.3 mcg/kg/minute (AHA [Peberdy 2010]; Hollenberg 2011; Manaker 2020; Elmer 2021).

Non–weight-based dosing (based on ~80 kg patient): IV: Initial: 5 to 15 mcg/minute; titrate based on clinical end points (eg, MAP, end-organ perfusion); usual dosing range: 5 to 80 mcg/minute; maximum dose range for refractory shock: 80 to 250 mcg/minute (doses calculated and rounded for an 80 kg patient based on weight-based dosing using the referenced sources (AHA [Peberdy 2010]; Hollenberg 2011; Manaker 2020; Elmer 2021).

Septic shock and other vasodilatory shock states

Septic shock and other vasodilatory shock states:

Note: In general, used to maintain goal MAP (eg, ~65 mm Hg); consider use if patient is in shock or has hypoperfusion during or after fluid resuscitation (Lamontagne 2020; Levy 2018; SSC [Evans 2021]). Institutional protocols may vary with weight-based or non-weight-based dose regimens.

Continuous infusion:

Weight-based dosing: IV: Initial: 0.05 to 0.15 mcg/kg/minute; titrate to goal MAP; usual dose range: 0.025 to 1 mcg/kg/minute; maximum dose range for refractory shock: 1 to 3.3 mcg/kg/minute (De Backer 2010; Hollenberg 2004; Hollenberg 2011; Manaker 2020; Martin 1990; Russell 2008). Note: While available data describe a wide range of initial dosing (0.01 to 0.5 mcg/kg/minute), initial dosing provided is a reasonable starting point for most patients.

Non–weight-based dosing (based on ~80 kg patient): IV: Initial: 5 to 15 mcg/minute; titrate to goal MAP; usual dose range: 2 to 80 mcg/minute; maximum dose range for refractory shock: 80 to 250 mcg/minute (doses calculated and rounded for an 80 kg patient based on weight-based dosing using the referenced sources (De Backer 2010; Hollenberg 2004; Hollenberg 2011; Manaker 2020; Martin 1990; Russell 2008).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

(For additional information see "Norepinephrine (noradrenaline): Pediatric drug information")

Note: Dose stated in terms of norepinephrine base.

Hypotension/shock, fluid-resistant: Infants, Children, and Adolescents: Continuous IV or intraosseous infusion: Initial: 0.05 to 0.1 mcg/kg/minute; titrate to desired effect; usual maximum dose: 2 mcg/kg/minute (AAP [Shenoi 2020]; ACCM [Davis 2017]; Bishop 2016; PALS [Kleinman 2010]; Park 2021); higher doses have been reported in the literature (Lampin 2012).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Obesity: Adult

The recommendations for dosing in patients with obesity are based upon the best available evidence and clinical expertise. Senior Editorial Team: Jeffrey F. Barletta, PharmD, FCCM; Manjunath P. Pai, PharmD, FCP; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC.

Class 1, 2, and 3 obesity (BMI ≥30 kg/m2):

Continuous infusion: IV: If institution uses weight-based dosing, use ideal body weight for initial weight-based dose calculations, then titrate to hemodynamic effect and clinical response (expert opinion). If institution uses nonweight-based dosing for vasoactive agents, continue with this approach. During therapy, clinicians should not change dosing weight from one weight metric to another (ie, ideal body weight to/from actual body weight or weight-based dosing to/from nonweight-based dosing) (Erstad 2021; expert opinion). Refer to adult dosing for indication-specific doses.

Rationale for recommendations: There is a paucity of studies evaluating the influence of obesity on norepinephrine dosing or pharmacokinetics. Observational studies, including norepinephrine, phenylephrine, and epinephrine, suggest nonweight-based dosing strategies may result in lower overall cumulative dose requirements and increased drug exposure to second-line agents in some patients and may not be advantageous in time to achieving hemodynamic stability (Adams 2017; Radosevich 2016; Vadiei 2017). However, it is difficult to show outcome differences between weight-based and nonweight-based dosing because of dose titration to target BP, particularly in the context of retrospective studies. Furthermore, there is substantial variability in response in critically ill patients, irrespective of weight. Due to the short onset of action and small Vd, rapid titration to clinical effect after initial dosing is possible (Erstad 2021).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Levophed: 1 mg/mL (4 mL) [contains sodium metabisulfite]

Generic: 1 mg/mL (4 mL); 16 mg/250 mL in Dextrose 5% (250 mL); 16 mg/250 mL in NaCl 0.9% (250 mL); 4 mg/250 mL in Dextrose 5% (250 mL); 4 mg/250 mL in NaCl 0.9% (250 mL); 8 mg/250 mL in Dextrose 5% (250 mL); 8 mg/250 mL in NaCl 0.9% (250 mL)

Solution, Intravenous [preservative free]:

Generic: 1 mg/mL (4 mL)

Generic Equivalent Available: US

Yes

Dosage Forms Considerations

Norepinephrine dosage is stated in terms of norepinephrine base. Although the IV product vial designates the contents as norepinephrine bitartrate, the actual concentration shown is in terms of norepinephrine base 1 mg/mL.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Levophed: 1 mg/mL (4 mL) [contains sodium metabisulfite]

Generic: 1 mg/mL (4 mL); 4 mg/250 mL in Dextrose 5% (250 mL); 8 mg/250 mL in Dextrose 5% (250 mL)

Administration: Adult

IV: Administer as a continuous infusion via an infusion pump. Dilute vials prior to use; a 4 mg per 250 mL and an 8 mg per 250 mL premixed solution are also available for IV infusion. Central line administration is preferred; extravasation may cause severe ischemic necrosis. If central line is not available, may administer for a short duration (<72 hours) through a peripheral IV catheter placed in a large vein at a proximal site (eg, in or proximal to antecubital fossa). Frequent monitoring of the IV catheter site is recommended to rapidly identify extravasation (Cardenas-Garcia 2015; Lewis 2019: Medlej 2018; Pancaro 2020; SSC [Evans 2021]; Tian 2020). Refer to institutional policies and procedures; catheter placement/size and vasopressor concentration may vary depending on institution. Administration through midline catheters may also be an option (Prasanna 2021). Do not administer sodium bicarbonate (or any alkaline solution) through an IV line containing norepinephrine; inactivation of norepinephrine may occur. Avoid abrupt withdrawal; reduce infusion flow rate slowly.

Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; elevate extremity. Initiate phentolamine (or alternative) antidote. Apply dry warm compresses (Hurst 2004; Reynolds 2014).

Phentolamine: Dilute 5 to 10 mg in 10 to 20 mL NS and administer into extravasation site as soon as possible after extravasation; may readminister if patient remains symptomatic (Reynolds 2014) or dilute 5 to 10 mg in 10 mL NS and administer into extravasation area (within 12 hours of extravasation).

Alternatives to phentolamine:

Nitroglycerin topical 2% ointment (based on limited data): Apply a 1-inch strip to the site of ischemia; may repeat every 8 hours as necessary (Reynolds 2014).

Terbutaline (based on limited case reports): Infiltrate extravasation area using a solution of terbutaline 1 mg diluted in 10 mL NS (large extravasation site, administration volume varied from 3 to 10 mL) or 1 mg diluted in 1 mL NS (small/distal extravasation site, administration volume varied from 0.5 to 1 mL) (Reynolds 2014; Stier 1999).

Administration: Pediatric

Parenteral: Continuous IV infusion: Administer as a continuous infusion via an infusion pump. Vials must be diluted prior to administration; premixed IV solutions (16 mcg/mL and 32 mcg/mL) are available. Central line administration is preferred; extravasation may cause severe ischemic necrosis. If central line is not available, may administer for a short duration through a peripheral IV catheter placed in a large vein or via intraosseous access using a more dilute solution or with a second carrier fluid (ACCM [Davis 2017]; SCCM/ESICM [Weiss 2020]); frequent monitoring of the IV catheter site is recommended to rapidly identify extravasation (Reynolds 2014). Note: Refer to institutional policies and procedures; catheter placement/size and vasopressor concentration may vary depending on institution. Do not administer sodium bicarbonate (or any alkaline solution) through an IV line containing norepinephrine; inactivation of norepinephrine may occur (AAP [Shenoi 2020]). Avoid abrupt withdrawal; reduce infusion flow rate slowly.

Rate of infusion (mL/hour) = dose (mcg/kg/minute) x weight (kg) x 60 minutes/hour divided by the concentration (mcg/mL)

Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; elevate extremity. Initiate phentolamine (or alternative) antidote (see Management of Drug Extravasations for more details). Apply dry warm compresses (Hurst 2004; Reynolds 2014).

Usual Infusion Concentrations: Adult

Note: Premixed solutions are available.

IV infusion: 4 mg in 250 mL (concentration: 16 mcg/mL) or 8 mg in 250 mL (concentration: 32 mcg/mL) of D5W or NS

Usual Infusion Concentrations: Pediatric

Note: Premixed solutions are available.

IV infusion: 16 mcg/mL, 32 mcg/mL, or 64 mcg/mL.

Use: Labeled Indications

Hypotension or shock: Treatment of severe hypotension, cardiogenic shock, or septic shock (and other vasodilatory shock states) that persist after adequate fluid volume replacement.

Use: Off-Label: Adult

Hepatorenal syndrome type 1 or acute kidney injury, treatment

Medication Safety Issues
Sound-alike/look-alike issues:

Levophed may be confused with levofloxacin

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Bradycardia, cardiac arrhythmia, cardiomyopathy (stress), peripheral vascular insufficiency

Central nervous system: Anxiety, transient headache

Respiratory: Dyspnea

<1%, postmarketing, and/or case reports: Peripheral gangrene, peripheral ischemia (digital [Daroca-Pérez 2017])

Contraindications

There are no contraindications listed in the manufacturer's labeling.

Canadian labeling: Additional contraindications (not in US labeling): Hypotension from hypovolemia except as an emergency measure to maintain coronary and cerebral perfusion until volume could be replaced; mesenteric or peripheral vascular thrombosis unless it is a lifesaving procedure; during anesthesia with cyclopropane or halothane anesthesia.

Documentation of allergenic cross-reactivity for vasopressors is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions

Concerns related to adverse effects:

• Extravasation: Vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation; infuse into a large vein if possible. Avoid infusion into leg veins. Monitor IV site closely. If extravasation occurs, infiltrate the area with diluted phentolamine (5 to 10 mg in 10 to 20 mL saline in adult patients) with a fine hypodermic needle. Phentolamine should be administered as soon as possible after extravasation is noted to prevent sloughing /necrosis.

Disease-related concerns:

• Hypovolemia: Address hypovolemia before initiating therapy; patients who are hypotensive from hypovolemia may experience severe peripheral and visceral vasoconstriction, decreased renal perfusion and reduced urine output, tissue hypoxia, lactic acidosis, and reduced systemic blood flow despite normal BP.

• Hypoxia/hypercarbia: Use in patients with profound hypoxia or hypercarbia may produce ventricular tachycardia or fibrillation; use with extreme caution.

Dosage form specific issues:

• Sodium metabisulfite: Product may contain sodium metabisulfite. Use caution in patients with asthma or a sulfite allergy; allergic-type reactions, including anaphylactic symptoms and life-threatening asthmatic episodes, may occur.

Other warnings/precautions:

• Abrupt discontinuation: Gradually reduce infusion rate while expanding blood volume with IV fluids during discontinuation of therapy; severe hypotension may occur with abrupt discontinuation.

• Appropriate use: Assure adequate circulatory volume to minimize need for vasoconstrictors. Avoid hypertension; monitor BP closely and adjust infusion rate. Avoid in patients with mesenteric or peripheral vascular thrombosis; use may increase ischemia and extend the area of infarction.

Metabolism/Transport Effects

Substrate of COMT

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize Alpha1-Blocker vasodilation. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Benzylpenicilloyl Polylysine: Alpha-/Beta-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Risk D: Consider therapy modification

Bretylium: May enhance the therapeutic effect of Alpha-/Beta-Agonists (Direct-Acting). Risk C: Monitor therapy

Bromocriptine: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider therapy modification

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Chloroprocaine: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

CloZAPine: May diminish the therapeutic effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification

COMT Inhibitors: May increase the serum concentration of COMT Substrates. Risk C: Monitor therapy

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy

Droxidopa: Norepinephrine may enhance the hypertensive effect of Droxidopa. Risk C: Monitor therapy

Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Risk X: Avoid combination

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Hyaluronidase: May enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Management: Avoid the use of hyaluronidase to enhance dispersion or absorption of alpha-/beta-agonists. Use of hyaluronidase for other purposes in patients receiving alpha-/beta-agonists may be considered as clinically indicated. Risk D: Consider therapy modification

Inhalational Anesthetics: May enhance the arrhythmogenic effect of Norepinephrine. Risk C: Monitor therapy

Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Risk D: Consider therapy modification

Lisuride: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Risk X: Avoid combination

Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of Norepinephrine. Risk C: Monitor therapy

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Pergolide: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the tachycardic effect of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitors may enhance the vasopressor effect of Alpha-/Beta-Agonists. Management: If possible, avoid coadministration of direct-acting alpha-/beta-agonists and serotonin/norepinephrine reuptake inhibitors. If coadministered, monitor for increased sympathomimetic effects (eg, increased blood pressure, chest pain, headache). Risk D: Consider therapy modification

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy

Spironolactone: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Tricyclic Antidepressants: May enhance the vasopressor effect of Alpha-/Beta-Agonists. Management: Avoid, if possible, the use of alpha-/beta-agonists in patients receiving tricyclic antidepressants. If combined, monitor for evidence of increased pressor effects and consider reductions in initial dosages of the alpha-/beta-agonist. Risk D: Consider therapy modification

Vasopressin: Alpha-/Beta-Agonists (Direct-Acting) may enhance the hypertensive effect of Vasopressin. The effect of other hemodynamic parameters may also be enhanced. Risk C: Monitor therapy

Pregnancy Considerations

Norepinephrine is an endogenous catecholamine and crosses the placenta (Minzter 2010; Wang 1999).

Medications used for the treatment of cardiac arrest in pregnancy are the same as in the non-pregnant woman. Appropriate medications should not be withheld due to concerns of fetal teratogenicity. Norepinephrine use during the post-resuscitation phase may be considered; however, the effects of vasoactive medications on the fetus should also be considered. Doses and indications should follow current Advanced Cardiovascular Life Support guidelines (Jeejeebhoy [AHA] 2015).

Breastfeeding Considerations

It is not known if norepinephrine is present in breast milk. The manufacturer recommends that caution be exercised when administering norepinephrine to breastfeeding women.

Monitoring Parameters

Blood pressure (or mean arterial pressure), heart rate; cardiac output (as appropriate), intravascular volume status, pulmonary capillary wedge pressure (as appropriate); urine output, peripheral perfusion; monitor infusion site closely

Consult individual institutional policies and procedures.

Mechanism of Action

Stimulates beta1-adrenergic receptors and alpha-adrenergic receptors causing increased contractility and heart rate as well as vasoconstriction, thereby increasing systemic blood pressure and coronary blood flow; clinically, alpha effects (vasoconstriction) are greater than beta effects (inotropic and chronotropic effects)

Pharmacokinetics

Onset of action: Very rapid acting.

Duration: Vasopressor: 1 to 2 minutes.

Distribution: Vd: 8.8 L.

Protein binding: 25% mainly albumin with smaller extent to prealbumin and alpha 1-acid glycoprotein.

Metabolism: Via catechol-o-methyltransferase and monoamine oxidase.

Half-life elimination: Mean: ~2.4 minutes.

Time to peak, serum: Steady state: 5 minutes.

Excretion: Urine (as inactive metabolites; small amounts as unchanged drug).

Pricing: US

Solution (Levophed Intravenous)

1 mg/mL (per mL): $6.13

Solution (Norepinephrine Bitartrate Intravenous)

1 mg/mL (per mL): $1.50 - $5.69

Solution (Norepinephrine-Dextrose Intravenous)

4MG/250ML 5% (per mL): $0.12

8MG/250ML 5% (per mL): $0.17

16MG/250ML 5% (per mL): $0.40

Solution (Norepinephrine-Sodium Chloride Intravenous)

4MG/250ML 0.9% (per mL): $0.14

8MG/250ML 0.9% (per mL): $0.22

16MG/250ML 0.9% (per mL): $0.40

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Adine (CL);
  • Adrenor (IN);
  • Adronis (IN);
  • Arespin (ID);
  • Arterenol (DE);
  • Cardiamed (MY);
  • Fioritina (AR);
  • Levofin (PH);
  • Levonor (PL, PY, UY, VN);
  • Levophed (BR, GB, HK, IE, LU);
  • Levophed Bitartrate (AE, AU, BE, BH, CY, IL, IQ, IR, JO, KR, LB, LY, MY, NZ, OM, PH, SA, SG, SY, TH, TW, YE);
  • Mephrin (PH);
  • N-Epi (TH);
  • Nobify (TW);
  • Nodresol (LK);
  • Norad (LK);
  • Noradren (GR);
  • Noradrenalina Tartrato (IT);
  • Noradrenaline (GB);
  • Noradrenaline Aguettant (FR);
  • Norages (ES);
  • Noralin (LK);
  • Norene (TH);
  • Norepin (PH);
  • Norepine (BE, TW);
  • Norphed (PH);
  • Norpin (KR, TH);
  • Pridam (CR, DO, GT, HN, NI, PA, SV);
  • Radrenit (CR, DO, GT, HN, NI, PA, SV);
  • Rhinopront (LU);
  • Sinora (PL);
  • Vascon (ID)


For country abbreviations used in Lexicomp (show table)
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  2. American Society of Health-System Pharmacists (ASHP). Pediatric continuous infusion standards. Available at https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/Pediatric-Infusion-Standards.ashx. Updated January 2021. Accessed February 9, 2022.
  3. Aron DC, Bravo EL, Kapcala LP. Erroneous Plasma Norepinephrine Levels With Radioimmunoassay. Ann Intern Med. 1983;98(6):1023.
  4. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 [PubMed 33942342]
  5. Bishop NB, Greenwald BM, Notterman DA. Pharmacology of the cardiovascular system. In: Fuhrman B, Zimmerman J, eds. Pediatric Critical Care. 5th ed. Elsevier Health; 2016: 352-379.
  6. Brierley J, Carcillo JA, Choong K, et al. Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: 2007 Update from the American College of Critical Care Medicine. Crit Care Med. 2009;37(2):666-688. [PubMed 19325359]
  7. Callaway CW, Donnino MW, Fink EL, et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18)(suppl 2):S465-S482. doi:10.1161/CIR.0000000000000262 [PubMed 26472996]
  8. Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015;10(9):581-585. doi:10.1002/jhm.2394 [PubMed 26014852]
  9. Cryer PE. Physiology and Pathophysiology of the Human Sympathoadrenal Neuroendocrine System. N Engl J Med. 1980;303(8):436-444. [PubMed 6248784]
  10. Daroca-Pérez R, Carrascosa MF. Digital necrosis: a potential risk of high-dose norepinephrine. Ther Adv Drug Saf. 2017;8(8):259-261. [PubMed 28781738]
  11. Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017;45(6):1061-1093.doi: 10.1097/CCM.0000000000002425. [PubMed 28509730]
  12. De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-789. doi:10.1056/NEJMoa0907118 [PubMed 20200382]
  13. Dempsey E, Rabe H. The use of cardiotonic drugs in neonates. Clin Perinatol. 2019;46(2):273-290. doi:10.1016/j.clp.2019.02.010 [PubMed 31010560]
  14. Denkler KA, Cohen BE. Reversal of Dopamine Extravasation Injury With Topical Nitroglycerin Ointment. Plast Reconstr Surg. 1989;84(5):811-813. [PubMed 2510208]
  15. Domonoske C. Appendix A: Common neonatal intensive care unit (NICU) medication guidelines. In: Eichenwald EC, Hansen AR, Martin CR, Stark AR. Cloherty and Stark's Manual of Neonatal Care. 8th edition. Lippincott Williams & Wilkins; 2017.
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