Norphed

Norphed

norepinephrine

Manufacturer:

Huons

Distributor:

Endure Medical
Full Prescribing Info
Contents
Norepinephrine bitartrate.
Description
Each mL contains: Norepinephrine (as Bitartrate) 1 mg.
Action
Pharmacology: The catecholamine, noradrenaline, is a direct acting sympathomimetic with pronounced effects on alpha adrenergic receptors and less marked effects on beta adrenergic receptors. It is a neurotransmitter, stored in granules in nerve axons, which is released in the terminations of post ganglionic adrenergic nerve fibers when they are stimulated; some is also present in the adrenal medulla from which they are liberated together with adrenaline. A major effect of noradrenaline is to raise systolic and diastolic blood pressure (which is accompanied by reflex slowing of the heart). This is a result of its Alpha stimulant effects which cause vasoconstriction, with reduced blood flow in the kidneys, liver, skin and usually skeletal muscle. The pregnant uterus also contracts; high doses liberate glucose from the liver and have other hormonal effects similar to those of adrenaline. There is little stimulation of the CNS. Beta-stimulant effects of noradrenaline have a positive inotropic action on the heart, but there is little bronchodilator effect.
Pharmacokinetics: Like epinephrine [adrenaline], norepinephrine [noradrenaline] is inactive when given by mouth, and it is rapidly inactivated in the body by similar processes. When given intravenously it is extensively metabolized and only small amounts are excreted unchanged in the urine of healthy subjects.
Indications/Uses
Noradrenaline [norepinephrine] is used for the emergency restoration of blood pressure in acute hypotensive states such as shock. Locally applied solutions have been used to control bleeding in upper gastrointestinal haemorrhage and similar disorders.
Dosage/Direction for Use
In acute hypotensive states, noradrenaline [norepinephrine] is administered as the acid tartrate by intravenous infusion of a solution containing the equivalent of 4 mcg of the base per mL in glucose 5% or sodium chloride 0.9% and glucose 5%. To avoid tissue necrosis, the infusion should be given through a central venous catheter or into large vein high up in a limb, preferably the arm. Some sources have suggested that addition of phentolamine 5 to 10 mg per liter to the infusion may prevent sloughing, should extravasations occur, without affecting the vasopressor action. The infusion is usually given initially at a rate of 2 to 3 mL per minute (8 to 12 mcg per minute) and adjusted according to the blood pressure response. Blood pressure is initially recorded every two minutes and the rate of infusion continuously monitored. The infusion must not be stopped suddenly but should be gradually withdrawn to avoid disastrous falls in blood pressure. The average maintenance dose is 0.5 to 1 mL per minute (2 to 4 mcg per minute), but there is a wide variation and higher dose may be required. The concentration of the infusion may be altered according to clinical needs. Alternatively a solution containing the equivalent of 40 mcg of the base per mL may be given at an initial rate of 0.16 to 0.33 mL per minute via a central nervous catheter, using a syringe pump or drip counter.
Similar doses may be given to restore blood pressure following cardiac arrest. In patients with cardiac standstill, a more concentrated solution of the acid tartrate equivalent to 100 mcg of the base per mL can be given by rapid intravenous or intracardiac injection; a dose of 0.5 to 0.75 mL (50 to 75 mcg of noradrenaline [norepinephrine]) has been suggested which may be repeated if necessary. Or as prescribed by the physician.
Warnings
This product contains sodium metabisulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible persons.
Special Precautions
Norepinephrine [noradrenaline] must be avoided in the presence of hypertension and blood pressure and infusion rate must be monitored frequently. Noradrenaline [norepinephrine]-induced cardiac arrhythmias are more likely in patients with hypoxia or hypercapnia. Hypovolaemia should be corrected before starting noradrenaline [norepinephrine] infusion.
Norepinephrine [noradrenaline] may reduce placental perfusion throughout pregnancy and some consider that it and similar vasoconstrictor sympathomimetics are best avoided; also in late pregnancy and some consider that it and similar vasoconstrictor sympathomimetics are best avoided; also in late pregnancy noradrenaline [norepinephrine] provokes uterine contractions which can result in fetal asphyxia.
Use In Pregnancy & Lactation
Norepinephrine [noradrenaline] may reduce placental perfusion throughout pregnancy and some consider that it and similar vasoconstrictor sympathomimetics are best avoided; also in late pregnancy and some consider that it and similar vasoconstrictor sympathomimetics are best avoided; also in late pregnancy noradrenaline [norepinephrine] provokes uterine contractions which can result in fetal asphyxia.
Adverse Reactions
Norepinephrine [noradrenaline] is an extremely potent peripheral vasoconstrictor and hypertension (possible associated with reflex bradycardia), headache and peripheral ischaemia, which may be severe enough to result in gangrene of the extremities, are among the potential adverse effects. Norepinephrine is a severe tissue irritant and only very dilute solutions should be injected. The needle must be inserted well into the vein to avoid extravasation, otherwise severe phlebitis and sloughing may occur.
Storage
Store at temperatures not exceeding 30°C.
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
Soln for inj (amp) 1 mg/mL x 2 mL x 10's.
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