Dosing and uses of Levarterenol, Levophed (norepinephrine)
Adult dosage forms and strengths
injectable solution
- 1mg/mL
Acute Hypotension
Initial: 8-12 mcg/min IV infusion; titrate to effect
Maintenance: 2-4 mcg/min IV infusion
Cardiac Arrest
Initial: 8-12 mcg/min IV infusion; titrate to effect
Maintenance: 2-4 mcg/min IV infusion
Sepsis & Septic Shock
0.01-3 mcg/kg/min IV infusion
Beta Blocker Toxicity (Off-label)
Should be titrated to age-appropriate blood pressure
Calcium Channel Blocker Toxicity (Off-label)
Should be titrated to age-appropriate blood pressure
Tricyclic Antidepressant Toxicity (Off-label)
Should be titrated to age-appropriate blood pressure
Pediatric dosage forms and strengths
injectable solution
- 1mg/mL
Acute Hypotension
Initial: 0.05-0.1 mcg/kg/min IV infusion; titrate to effect
Maximum: 1-2 mcg/kg/min
Cardiac Arrest
Initial: 0.05-0.1 mcg/kg/min IV infusion; titrate to effect
Maximum: 1-2 mcg/kg/min
Shock
0.05-0.1 mcg/kg/min IV infusion; titrate to effect; not to exceed 2 mcg/kg/min
Levarterenol, Levophed (norepinephrine) adverse (side) effects
Frequency not defined
Bradycardia
Hypertension
Arrhythmias
Confusion
Anxiety
Dyspnea, with or without respiratory difficulty
Headache
Nausea and vomiting
Sweating
Tremor
Restlessness
Urinary retention
Extravasation
Gangrene
Warnings
Black box warnings
Antidote for extravasation ischemia: To prevent sloughing and necrosis in areas where extravasation has taken place, infiltrate areas promptly with 10-15 mL of saline solution containing 5-10 mg of phentolamine mesylate for injection
Use syringe with fine hypodermic needle, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, pallid appearance
Contraindications
Hypersensitivity
Hypotension due to blood volume deficit
Peripheral vascular thrombosis (except for lifesaving procedures)
Concomitant use with some general anesthetics: Chloroform, trichloroethylene, cyclopropane, halothane
Cautions
Mesenteric or peripheral vascular thrombosis
Avoid infusion site extravasation
Not for use in profound hypoxia
Sulfite allergy due to presence of metabisulfite
Monitor blood pressure
Extreme caution in concurrent monoamine oxidase inhibitor (MAOI) use
Pregnancy and lactation
Pregnancy category: C
Lactation: Not known if excreted into breast milk; avoid use during breastfeeding
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Levarterenol, Levophed (norepinephrine)
Mechanism of action
Strong beta1- and alpha-adrenergic effects and moderate beta2 effects, which increase cardiac output and heart rate, decrease renal perfusion and PVR, and cause variable BP effects
Absorption
Onset: 1-2 min
Duration: 1-2 min (vasopressor)
Metabolism
Metabolized by MAO and catechol-O-methyl transferase (COMT) in the adrenergic neuron
Metabolites: Normetanephrine, vanillylmandelic acid (inactive)
Elimination
Excretion: Urine (84-96%)
Administration
IV Incompatibilities
Additive: Aminophylline, pentobarbitaL
Not spec: Atropine, carbenicillin, cefazolin, diazepam
IV Compatibilities
Additive: Calcium gluconate, cimetidine, dobutamine, heparin, KCl, verapamil, vitamins B/C
Syringe: Heparin
Y-site: Amiodarone, epinephrine, esmolol, fentanyl, furosemide, heparin, hydrocortisone, KCl, vitamins B/C
Not spec: Tetracycline
IV Preparation
Solution: 4 mg in 1000 ml D5W (4 mcg/ml); 40 ml/hr (~3 mcg/min); dose may be titrated to patient response
IV Administration
Into large vein; central line required
Do not administer NaHCO3 through an IV line containing norepinephrine
