N-EPI should not be given to patients who are hypersensitivity to noradrenaline tartrate or to any of the excipients (Sodium chloride, Sodium Metabisulfite, Citric acid monohydrate, and Sodium citrate dihydrate).
N-EPI should not be given to patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed. If N-EPI is continuously administered to maintain blood pressure in the absence of blood volume replacement, the following may occur: Severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite "normal" blood pressure, tissue hypoxia and lactate acidosis.
N-EPI should not also be given to patients with mesenteric or peripheral vascular thrombosis (because of the risk of increasing ischemia and extending the area of infarction) unless, in the opinion of the attending physician, the administration of N-EPI is necessary as a life-saving procedure.
Cyclopropane and halothane anaesthetics increase cardiac autonomic irritability and therefore, seem to sensitize the myocardium to the action of intravenously administered epinephrine or norepinephrine. Hence, the use of N-EPI during cyclopropane and halothane anaesthesia is generally considered contraindicated because of the risk of producing ventricular tachycardia or fibrillation.
The same type of cardiac arrhythmias may result from the use of N-EPI in patients with profound hypoxia or hypercarbia.