Monoamine Oxidase Inhibitors and Tricyclic Antidepressants: Noradrenaline should be used with caution in patients receiving monoamine oxidase (MAO) inhibitors or tricyclic antidepressants, because severe, prolonged hypertension may result.
General: Particular caution should be observed in patients with coronary, mesenteric or peripheral vascular thrombosis because noradrenaline may increase the ischemia and extend the area of infarction. Similar caution should be observed in patients with hypotension following myocardial infarction, in patients with Prinzmetal's variant angina, and in patients with diabetes, hypertension or hyperthyroidism.
Noradrenaline should only be administered by healthcare professionals who are familiar with its use.
Noradrenaline should be used with caution in patients who exhibit profound hypoxia or hypercarbia.
Extravasation: Extravasation of the solution may cause local tissue necrosis. The infusion site should be checked frequently. If extravasation occurs, the infusion should be stopped, and the area should be infiltrated with phentolamine without delay.
Fluid Replacement: Noradrenaline should be used only in conjunction with appropriate blood volume replacement. When infusing noradrenaline, the blood pressure and rate of flow should be checked frequently to avoid hypertension.
Prolonged administration of any potent vasopressor may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy. If plasma volumes are not corrected, hypotension may recur when the infusion is discontinued, or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g., decreased renal perfusion) with reduced blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury.
Withdrawal of Therapy: The noradrenaline infusion should be gradually decreased since abrupt withdrawal can result in acute hypotension.
Effects on Ability to Drive and Use Machines: The effect of the medicinal product on the ability to drive or use machines has not been systematically evaluated. Patients should refrain from driving or using machines until they know that the medicinal product does not negatively affect these abilities.
Use in Children: The use of noradrenaline in children is not recommended.