Efrala

Efrala

norepinephrine

Manufacturer:

Kalbe Farma
Full Prescribing Info
Contents
Norepinephrine bitartrate.
Action
Norepinephrine acts as a peripheral vascular vasoconstrictor (α-adrenergic action), an inotropic stimulator of the heart, and a coronary artery dilator (β-adrenergic action).
Indications/Uses
To control blood pressure in certain cases of acute hypotension (for example: pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions). Adjuvant therapy for cardiac arrest and severe hypotension.
Dosage/Direction for Use
Blood Pressure Restoration in Acute Hypotensive: Prevalent dose: Add one ampule (4 mg/4 mL) EFRALA to 1000 mL of a solution containing 5% dextrose. Each mL of the dilution solution contains 4 mcg EFRALA. Give the solution via intravenous infusion. Insert the intravenous catheter through the bore needle that is in full central depth into the vein, and firmly fixed with plaster. An intravenous drip device or other suitable measuring device is very important to be able to estimate the flow rate in drops per minute. After observing the response to the initial dose of 2-3 mL (from 8-12 mcg of base fluid) every minute, it is necessary to regulate fluid flow rates to achieve and maintain a low normal blood pressure (usually 80-100 mmHg for systolic blood pressure), which enough to maintain circulation to vital organs. In patients previously diagnosed with hypertension, the recommended increase in blood pressure does not exceed 40 mmHg below the previous systolic blood pressure. The recommended maintenance dose is between 0.5 - 1 mL per minute (from 2-4 mcg of basic liquid). High dose: In all cases, the EFRALA dose must be titrated according to the patient's response. Sometimes a very large EFRALA dose (up to a maximum of 68 mg or 17 ampules) is required if the patient remains hypotensive, but occult blood volume depletion should always be estimated and always corrected if it occurs. Monitoring of central venous pressure can usually help in detecting and handling such situations.
Adjuvant therapy for cardiac arrest: EFRALA is used in the same way as described in the section on Blood Pressure Restoration in Acute Hypotensive.
Overdosage
Symptoms of overdose are including headache, severe hypertension, reflex bradycardia, marked increase in peripheral resistance, and decreased cardiac output.
Treatment of overdose: In cases of accidental overdose, usually indicated by excessive blood pressure increase, it is recommended to stop EFRALA therapy until the patient's condition is stable.
Contraindications
Patients who experience hypotension due to blood volume deficits, except as emergency measures to maintain coronary and cerebral artery perfusion until blood replacement therapy can be completed.
Patients with mesenteric or peripheral vascular thrombosis due to the risk of increased ischemia and expansion of the infarct area.
Cyclopropane and halothane anesthetics can increase the autonomic irritability of the heart and therefore seem to sensitize the myocardium to the action of epinephrine or norepinephrine given intravenously. Hence, the use of EFRALA during cyclopropane and halothane anesthesia is generally considered contraindicated because of the risk of producing ventricular tachycardia or fibrillation. The same type of cardiac arrhythmias can be caused by the administration of EFRALA in patients with severe hypoxia or hypercarbia.
Special Precautions
Administration in patients receiving monoamine oxidase inhibitor (MAOI) or antidepressants of tryptylline or imipramine must be done very carefully, because it can lead to severe hypertension that lasts a long time. EFRALA contains sodium metabisulfite, a sulfite that may causes allergic type reactions, including symptoms of anaphylaxis and episodes of life-threatening asthma or milder episodes of asthma in certain people who are susceptible to them. Pregnancy and lactation. Elderly.
Adverse Reactions
General: ischemic injury caused by strong vasoconstrictor effects and tissue hypoxia.
Cardiovascular system: bradycardia (which may occur caused by reflexes due to increased blood pressure), arrhythmias.
Nervous system: anxiety, temporary headaches.
Respiratory system: breathing difficulty.
Skin: extravasation necrosis at the injection site.
Drug Interactions
Cyclopropane and halothane anesthetics may increase the autonomic irritability of the heart and therefore seem to sensitize the myocardium to the action of epinephrine or norepinephrine those are given intravenously. Therefore, the use of EFRALA during anesthesia with cyclopropane and halothane is contraindicated because of the risk in developing ventricular tachycardia or fibrillation. The same type of cardiac arrhythmias may cause by the administration of EFRALA in patients with severe hypoxia or hypercarbia. EFRALA should be used with caution in patients who are treated with monoamine oxidase inhibitors (MAOI) or antidepressants of tryptyline or imipramine, because it may result in severe hypertension that lasts a long time.
Storage
Store in the temperature below 25°C. Keep away from sunlight and heat.
MIMS Class
ATC Classification
C01CA03 - norepinephrine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of hypotension.
Presentation/Packing
Inj (amp) 4 mg/4 mL x 4 mL x 5's.
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in