Norepinephrine
Dosing in kidney impairment
Allergic Reactions with Sulfite: Norepinephrine Bitartrate Injection contains sodium metabisulfite. Sulfite may cause allergic-type-reactions. 5.1 Tissue Ischemia Administration of Norepinephrine Bitartrate Injection to patients who are hypotensive from hypovolemia can result in severe peripheral and visceral vasoconstriction, decreased renal perfusion and reduced urine output, tissue hypoxia, lactic acidosis, and reduced systemic blood flow despite "normal" blood pressure.
Preparation and administration
Important Dosage and Administration Instructions Correct Hypovolemia Address hypovolemia before initiation of Norepinephrine Bitartrate Injection therapy. If the patient does not respond to therapy, suspect occult hypovolemia [ see Warnings and Precautions ]. Administration Dilute Norepinephrine Bitartrate Injection prior to use [ see Dosage and Administration ].
Infuse Norepinephrine Bitartrate Injection into a large vein. Avoid infusions into the veins of the leg in the elderly or in patients with occlusive vascular disease of the legs [ see Warnings and Precautions ]. Avoid using a catheter-tie-in technique. Discontinuation When discontinuing the infusion, reduce the flow rate gradually.
Avoid abrupt withdrawal.
Dosage After an initial dosage of 8 to 12 mcg per minute via intravenous infusion, assess patient response and adjust dosage to maintain desired hemodynamic effect. Monitor blood pressure every two minutes until the desired hemodynamic effect is achieved, and then monitor blood pressure every five minutes for the duration of the infusion.
Typical maintenance intravenous dosage is 2 to 4 mcg per minute.
Preparation of Diluted Solution Visually inspect Norepinephrine Bitartrate Injection for particulate matter and discoloration prior to administration (the solution is colorless). Do not use the solution if its color is pinkish or darker than slightly yellow or if it contains a precipitate. Add the content of one Norepinephrine Bitartrate Injection vial (4 mg in 4 mL) to 1,000 mL of 5% Dextrose Injection, USP or Sodium Chloride Injection solutions that contain 5% dextrose to produce a 4 mcg per mL dilution.
Dextrose reduces loss of potency due to oxidation. Administration in saline solution alone is not recommended. Use higher concentration solutions in patients requiring fluid restriction. Prior to use, store the diluted Norepinephrine Bitartrate Injection solution for up to 24 hours at room temperature [20°C to 25°C (68°F to 77°F)] and protect from light.
Drug Incompatibilities Avoid contact with iron salts, alkalis, or oxidizing agents. Whole blood or plasma, if indicated to increase blood volume, should be administered separately.