Side effects of norepinephrine

Norepinephrine Side Effects

Medically reviewed by Drugs.com. Last updated on Jul 29, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

For the Consumer

Applies to norepinephrine: parenteral injection

Warning

    Extravasation Risk

  • Phentolamine is the local antidote for peripheral ischemia resulting from extravasation of norepinephrine.101
  • Phentolamine should be given as soon as possible after extravasation is noted.101
  • Infiltrate the affected area (using a syringe with a fine hypodermic needle) liberally throughout as soon as possible with 10–15 mL of 0.9% sodium chloride injection containing 5–10 mg of phentolamine mesylate (an α-adrenergic blocking agent) to prevent sloughing and necrosis in ischemic areas.101
  • Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours.101

Side effects include:

May cause headache, anxiety, arrhythmias, bradycardia, respiratory difficulty, ischemic injury, or extravasation at the infusion site.

For Healthcare Professionals

Applies to norepinephrine: injectable solution, intravenous solution

General

If plasma volumes are not corrected, hypotension may recur when this drug is discontinued, or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g., decreased renal perfusion) with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury. Overdoses or conventional doses in hypersensitive patients (e.g., hyperthyroid patients) can cause severe hypertension with violent headache, photophobia, stabbing retrosternal pain, pallor, intense sweating, and vomiting.

Local

Frequency not reported: Extravasation necrosis

Cardiovascular

Frequency not reported: Ischemic injury, bradycardia, arrhythmia, blood pressure increased, hypertension, pallor, stabbing retrosternal pain

Nervous system

Frequency not reported: Headache

Dermatologic

Frequency not reported: Sweating

Gastrointestinal

Frequency not reported: Vomiting

Ocular

Frequency not reported: Photophobia

Metabolic

Frequency not reported: Plasma volume depletion

Psychiatric

Frequency not reported: Anxiety

Respiratory

Frequency not reported: Respiratory difficulty, dyspnea

Other

Frequency not reported: Gangrene

1. “Product Information. Levophed (norepinephrine).” Hospira Inc, Lake Forest, IL.

2. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0

3. Cerner Multum, Inc. “Australian Product Information.” O 0

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Related questions

  • Strattera vs Adderall: What is the difference?
  • Norepinephrine vs epinephrine: what’s the difference?
  • What are some common side effects of antidepressants?

Medical Disclaimer

More about norepinephrine

  • During Pregnancy or Breastfeeding
  • Dosage Information
  • Drug Interactions
  • Support Group
  • Pricing & Coupons
  • En Español
  • 1 Review
  • Drug class: catecholamines
  • FDA Alerts (1)

Consumer resources

  • Norepinephrine

Other brands: Levophed

Professional resources

  • Norepinephrine Bitartrate (AHFS Monograph)
  • … +3 more

Related treatment guides

  • Shock
  • Hypotension

What is it used for?

  • Treating sudden, life-threatening low blood pressure (acute hypotension).

How does it work?

Noradrenaline is a hormone that is produced naturally by the body. It is given by injection to treat life-threatening drops in blood pressure. (NB. Noradrenaline is sometimes also referred to as norepinephrine.)

Noradrenaline produces wide ranging effects on many areas of the body and is often referred to as a ‘fight or flight’ chemical, as it is responsible for the body’s reaction to stressful situations.

Noradrenaline normally produces effects such as increased heart rate, increased blood pressure, widening of pupils, widening of air passages in the lungs and narrowing of blood vessels in non-essential organs. This enables the body to perform well in stressful situations.

Noradrenaline works by stimulating receptors called adrenoceptors, which are found all over the body. When injected into a vein, noradrenaline acts mostly on a type of adrenoceptor known as an alpha receptor. These are found on muscle inside the walls of peripheral blood vessels. Stimulating these alpha receptors causes the muscle to contract, which makes the blood vessels constrict and narrow.

By narrowing the blood vessels in the extremities, noradrenaline redirects blood to essential organs such as the heart and brain. It also produces greater resistance for the heart to beat against, and this increases blood pressure.

Noradrenaline is used to restore blood pressure to normal in emergency situations when blood pressure has dropped dangerously low.

How is this medicine given?

  • Noradrenaline is given via a drip into a vein (intravenous infusion).

Not to be used in

  • People with high blood pressure.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Use with caution in

  • People with a blood clot in the artery that supplies blood to the heart (coronary thrombosis or heart attack).
  • People with a blood clot in one of the blood vessels in the extremities (peripheral vascular thrombosis).
  • People with a blood clot in the artery that supplies blood to the intestines (mesenteric thrombosis).
  • People with low blood pressure following a heart attack.
  • People with a severe form of angina pectoris, not caused by exertion (Prinzmetal’s angina).
  • People with an overactive thyroid gland (hyperthyroidism).
  • Diabetes.
  • People with low levels of oxygen in the tissues (hypoxia).
  • People with an abnormally high amount of carbon dioxide in the blood (hypercapnia).
  • Elderly people.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • Noradrenaline can reduce the blood supply to the placenta. It should only be used during pregnancy in an emergency, where the expected benefit to the mother is greater than any possible risks to the developing baby. Seek further medical advice from your doctor.
  • There is no information available regarding the safety of this medicine during breastfeeding. However, it is poorly absorbed from the gut so any noradrenaline that did pass into breast milk would be unlikely to affect a nursing infant. High intravenous doses of the medicine might reduce milk production or milk letdown. Seek further medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Loss of appetite.
  • Feeling sick and vomiting.
  • Reduced oxygen supply around the body (hypoxia), particularly in the tissues of the extremities (peripheral ischaemia).
  • Awareness of your heartbeat (palpitations).
  • Irregular heartbeats (arrhythmias).
  • Slower or faster heart rate (bradycardia or tachycardia).
  • High blood pressure (hypertension).
  • Shortness of breath.
  • Headache.
  • Difficulty sleeping.
  • Anxiety.
  • Tremor.
  • Confusion.
  • Weakness.
  • Difficulty passing urine.
  • Raised pressure in the eyeball (closed angle glaucoma).

The side effects listed above may not include all of the side effects reported by the medicine’s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

There may be an increased risk of the blood pressure rising too high or effects on the heart rate or rhythm if this medicine is used in people taking any of the following medicines:

  • beta-blockers such as propranolol
  • general anaesthetics
  • linezolid
  • MAOI antidepressants such as phenelzine
  • rasagiline or selegiline for Parkinson’s disease
  • tricyclic antidepressants such as amitriptyline.

Last updated 22.04.2014

Levophed

DOSAGE AND ADMINISTRATION

Norepinephrine Bitartrate Injection is a concentrated, potent drug which must be diluted in dextrose containing solutions prior to infusion. An infusion of LEVOPHED should be given into a large vein (see PRECAUTIONS).

Restoration Of Blood Pressure In Acute Hypotensive States

Blood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, LEVOPHED can be administered before and concurrently with blood volume replacement.

Diluent

LEVOPHED should be diluted in 5 percent dextrose injection or 5 percent dextrose and sodium chloride injections. These dextrose containing fluids are protection against significant loss of potency due to oxidation. Administration in saline solution alone is not recommended. Whole blood or plasma, if indicated to increase blood volume, should be administered separately (for example, by use of a Y-tube and individual containers if given simultaneously).

Average Dosage

Add a 4 mL ampul (4 mg) of LEVOPHED to 1,000 mL of a 5 percent dextrose containing solution. Each mL of this dilution contains 4 mcg of the base of LEVOPHED. Give this solution by intravenous infusion. Insert a plastic intravenous catheter through a suitable bore needle well advanced centrally into the vein and securely fixed with adhesive tape, avoiding, if possible, a catheter tie-in technique as this promotes stasis. An IV drip chamber or other suitable metering device is essential to permit an accurate estimation of the rate of flow in drops per minute. After observing the response to an initial dose of 2 mL to 3 mL (from 8 mcg to 12 mcg of base) per minute, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 mm Hg to 100 mm Hg systolic) sufficient to maintain the circulation to vital organs. In previously hypertensive patients, it is recommended that the blood pressure should be raised no higher than 40 mm Hg below the preexisting systolic pressure. The average maintenance dose ranges from 0.5 mL to 1 mL per minute (from 2 mcg to 4 mcg of base).

High Dosage

Great individual variation occurs in the dose required to attain and maintain an adequate blood pressure. In all cases, dosage of LEVOPHED should be titrated according to the response of the patient. Occasionally much larger or even enormous daily doses (as high as 68 mg base or 17 ampuls) may be necessary if the patient remains hypotensive, but occult blood volume depletion should always be suspected and corrected when present. Central venous pressure monitoring is usually helpful in detecting and treating this situation.

Fluid Intake

The degree of dilution depends on clinical fluid volume requirements. If large volumes of fluid (dextrose) are needed at a flow rate that would involve an excessive dose of the pressor agent per unit of time, a solution more dilute than 4 mcg per mL should be used. On the other hand, when large volumes of fluid are clinically undesirable, a concentration greater than 4 mcg per mL may be necessary.

Duration Of Therapy

The infusion should be continued until adequate blood pressure and tissue perfusion are maintained without therapy. Infusions of LEVOPHED should be reduced gradually, avoiding abrupt withdrawal. In some of the reported cases of vascular collapse due to acute myocardial infarction, treatment was required for up to six days.

Adjunctive Treatment In Cardiac Arrest

Infusions of LEVOPHED are usually administered intravenously during cardiac resuscitation to restore and maintain an adequate blood pressure after an effective heartbeat and ventilation have been established by other means.

To maintain systemic blood pressure during the management of cardiac arrest, LEVOPHED is used in the same manner as described under Restoration of Blood Pressure in Acute  Hypotensive States.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to use, whenever solution and container permit.

Do not use the solution if its color is pinkish or darker than slightly yellow or if it contains a precipitate.

Avoid contact with iron salts, alkalis, or oxidizing agents.

HOW SUPPLIED

LEVOPHED, norepinephrine bitartrate injection, USP, contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL).

Supplied as:

Ampuls of 4 mL in boxes of 10, NDC 0409-1443-04

Store at 20 to 25°C (68 to 77°F).

Protect from light.

Hospira, Inc., Lake Forest, IL 60045 USA. Revised: Nov 2009

Generic Name: norepinephrine (nor ep i NEF rin)
Brand Name: Levophed

Medically reviewed by Drugs.com on Jun 28, 2019 – Written by Cerner Multum

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

What is Levophed?

Levophed is similar to adrenaline. It is used to treat life-threatening low blood pressure (hypotension) that can occur with certain medical conditions or surgical procedures. This medicine is often used during CPR (cardio-pulmonary resuscitation).

Levophed may also be used for purposes not listed in this medication guide.

Important Information

Tell your caregivers at once if you have a serious side effect such as a cold feeling anywhere in your body, blue lips or fingernails, trouble breathing, little or no urination, irritation or skin changes where the medicine was injected, slow heart rate, sudden numbness or weakness, severe headache, or problems with vision, speech, or balance.

Before taking this medicine

If possible before you receive Levophed, tell your caregivers if you have:

  • high blood pressure (hypertension);

  • diabetes;

  • coronary artery disease;

  • circulation problems;

  • varicose veins;

  • overactive thyroid; or

  • asthma or a sulfite allergy.

Tell your doctor if you are pregnant or breastfeeding.

In an emergency, you may not be able to tell caregivers about your health conditions or if you are pregnant or breastfeeding. Make sure any doctor caring for you afterward knows you received Levophed.

How is Levophed given?

Levophed is given as an infusion into a vein. A healthcare provider will give you this injection.

Levophed is usually given for as long as needed until your body responds to the medication. Some people must receive this medicine for several days.

Your blood pressure, breathing, and other vital signs will be watched closely while you are receiving Levophed.

Tell your caregivers if you feel any pain, irritation, cold feeling, or other discomfort of your skin or veins where the medicine is injected. Levophed can damage the skin or tissues around the injection site if the medicine accidentally leaks out of the vein.

What happens if I miss a dose?

Since Levophed is given by a healthcare professional in an emergency setting, you are not likely to miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include slow heartbeats, severe headache, sweating, vomiting, increased sensitivity to light, pale skin, and stabbing chest pain.

What should I avoid while receiving Levophed?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Levophed side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers at once if you have:

  • pain, burning, irritation, discoloration, or skin changes where the injection was given;

  • sudden numbness, weakness, or cold feeling anywhere in your body;

  • slow or uneven heart rate;

  • blue lips or fingernails, mottled skin;

  • little or no urination;

  • trouble breathing;

  • problems with vision, speech, or balance; or

  • severe headache, blurred vision, pounding in your neck or ears.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Levophed?

If possible before you receive Levophed, tell your doctor about all your other medicines, especially:

  • an antidepressant;

  • blood pressure medication; or

  • an MAO inhibitor–isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

This list is not complete. Other drugs may affect Levophed, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 5.01.

  • Strattera vs Adderall: What is the difference?
  • Norepinephrine vs epinephrine: what’s the difference?
  • What are some common side effects of antidepressants?

Medical Disclaimer

More about Levophed (norepinephrine)

  • Side Effects
  • During Pregnancy or Breastfeeding
  • Dosage Information
  • Drug Interactions
  • Pricing & Coupons
  • En Español
  • 1 Review
  • Generic Availability
  • Drug class: catecholamines
  • FDA Alerts (2)
  • Levophed
  • Levophed (AHFS Monograph)
  • … +1 more
  • Hypotension
  • Shock

When (And When Not) To Use Norepinephrine (Levophed) in the ICU

There are a variety of vasopressors that are used to treat shock in the ICU. A vasopressor is a medication that literally makes the veins squeeze themselves tighter which raises blood pressure. Some of the common vasopressors that are used include dopamine, neosynephrine, epinephrine, and norepinephrine.

In our ICU, usually the first vasopressor of choice is norepinephrine. The majority of our patients requiring this medication are in septic shock. Norepinephrine will raise a patient’s blood pressure but not their heart rate. Technically, Levophed does have beta-1 adrenergic effects (which would elevate the heart rate), but these effects are minimal. This is advantageous in septic shock patients because their heart rates are already elevated.

The brand name of norepinephrine is Levophed. Many of the older nurses have said that they used to say, “Levophed, leave ’em dead.” If patients were sick enough to require norepinephrine to manage their shock, then they were most likely going to die. Luckily, we have learned that norepinephrine is a great medication to treat hypotension if used correctly.

Pharmacy Information

The brand name of norepinephrine is Levophed. The dose that we usually give patients is 1-30 mcg/min continuously through a central line. The most frequent nursing intervention when this medication is infusing is checking the patient’s blood pressure. We check the blood pressure every 15 minutes or continuously (if the patient has an arterial line). In high doses, norephinephrine can cause acute kidney injury. The medication is narrowing the veins (including the renal veins) which causes decreased perfusion to the kidneys. All medications have side effects that may not be desirable. In this case, keeping the patient’s blood pressure normal is the priority.

It is a beta-1 and alpha-adrenergic agonist, meaning it activates those receptors.

  • Beta 1 Receptors: Increases myocardial contraction (strength of the heart beat) and increases the heart rate.
  • Alpha Receptors: Vasoconstriction, increased peripheral vascular resistance, and increased arterial blood pressure.

Norepinephrine is a very potent medication and requires a central line for administration. We may sometimes give it in low doses through a large bore peripheral IV while the provider is placing the central line. If the IV were to infiltrate, give the required subcutaneous dose of tertbutaline to stop the necrosis caused by the norepinephrine.

norepinephrine

Generic Name: norepinephrine

  • What is norepinephrine?
  • What are the possible side effects of norepinephrine?
  • What is the most important information I should know about norepinephrine?
  • What should I discuss with my health care provider before receiving norepinephrine?
  • How is norepinephrine given?
  • What happens if I miss a dose?
  • What happens if I overdose?
  • What should I avoid while receiving norepinephrine?
  • What other drugs will affect norepinephrine?
  • Where can I get more information?

What is norepinephrine?

Norepinephrine is similar to adrenaline. It is used to treat life-threatening low blood pressure (hypotension) that can occur with certain medical conditions or surgical procedures. Norepinephrine is often used during CPR (cardio-pulmonary resuscitation).

Norepinephrine may also be used for purposes not listed in this medication guide.

What are the possible side effects of norepinephrine?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers at once if you have:

  • pain, burning, irritation, discoloration, or skin changes where the injection was given;
  • sudden numbness, weakness, or cold feeling anywhere in your body;
  • slow or uneven heart rate;
  • blue lips or fingernails, mottled skin;
  • little or no urination;
  • trouble breathing;
  • problems with vision, speech, or balance; or
  • severe headache, blurred vision, pounding in your neck or ears.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about norepinephrine?

Tell your caregivers at once if you have a serious side effect such as a cold feeling anywhere in your body, blue lips or fingernails, trouble breathing, little or no urination, irritation or skin changes where the medicine was injected, slow heart rate, sudden numbness or weakness, severe headache, or problems with vision, speech, or balance.

Norepinephrine also called noradrenaline is both a hormone, produced by the adrenal glands, and a neurotransmitter, a chemical messenger which transmits signals across nerve endings in the body. Norepinephrine is produced in the inner part of the adrenal glands, also called the adrenal medulla. The adrenal medulla also makes adrenaline (also known as epinephrine). Norepinephrine, adrenaline and dopamine belong are part of the catecholamine family. Adrenal glands are making primarily adrenaline and most of the norepinephrine in the blood comes from nerve endings. It plays a role in your mood and ability to concentrate. Together with other hormones, norepinephrine helps the body respond to stress and exercise. Other hormones include:

  • Adrenaline
  • Cortisol
  • Corticotropin releasing hormone
  • Adrenocorticol hormone

What Does Norepinephrine Do?

Together with adrenaline, norepinephrine increases heart rate and blood pumping from the heart. It also increases blood pressure and helps break down fat and increase blood sugar levels to provide more energy to the body.

In the brain, norepinephrine plays a role in the sleep-wake cycle, helping you to wake up, in increasing attention and focusing on performing a task ,and in memory storage. It is also important for emotions. Problems with norepinephrine levels are associated with depression, anxiety, post-traumatic stress disorder and substance abuse. Bursts of norepinephrine can lead to euphoria (very happy) feelings but are also linked to panic attacks, elevated blood pressure, and hyperactivity. Low levels can cause lethargy (lack of energy), lack of concentration, attention deficit hyperactivity disorder (ADHD), and possibly depression. Some anti-depressant medications affect norepinephrine levels in the brain.

In stressful situations, norepinephrine increases as part of the fight or flight response to mobilize the brain and body for action.

Norepinephrine can be used to treat low blood pressure (hypotension) that can occur during certain medical procedures or life-threatening situations where cardiopulmonary resuscitation (CPR) is needed.

How Can you Increase Norepinephrine Naturally?

Norepinephrine and serotonin are a great pair. These chemicals help combat antidepressant effects and have therapeutic benefits. Serotonin, also called a “feel-good” hormone, improves mood and norepinephrine improves alertness and energy. You can boost these chemicals naturally through:

  • Exercise
  • Sleep
  • Small accomplishments
  • Music
  • Meditation
  • Eating dopamine rich foods such as chocolate

Questions to ask your doctor

  • How does norepinephrine affect my mood?
  • How can I improve my norepinephrine and serotonin levels?
  • Is my high blood pressure due to too much norepinephrine or adrenaline?

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