Dangerous Drug: Norepinephrine Bitartrate (Levarterenol)(nor ep i nef’ rin)
Levophed
PREGNANCY CATEGORY C
Drug Classes
Alpha-adrenergic agonist
Beta1-adrenergic agonist
Cardiac stimulant
Sympathomimetic
Vasopressor
Therapeutic Actions
Vasopressor and cardiac stimulant; effects are mediated by alpha1– or beta1-adrenergic receptors in target organs; potent vasoconstrictor (alpha effect) acting in arterial and venous beds; potent positive inotropic agent (beta1 effect), increasing the force of myocardial contraction and increasing coronary blood flow.
Indications
Restoration of BP in controlling certain acute hypotensive states (pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, MI, septicemia, blood transfusion, and drug reactions)
Adjunct in the treatment of cardiac arrest and profound hypotension
Contraindications and Cautions
Contraindicated with hypovolemia (not a substitute for restoration of fluids, plasma, electrolytes, and should not be used when there are blood volume deficits except as an emergency measure to maintain coronary and cerebral perfusion until blood volume replacement can be effected; if administered continuously to maintain BP when there is hypovolemia, perfusion of vital organs may be severely compromised and tissue hypoxia
may result); general anesthesia with halogenated hydrocarbons or cyclopropane; profound hypoxia or hypercarbia; mesenteric or peripheral vascular thrombosis (risk of extending the infarct).
Use cautiously with pregnancy, lactation.
Available Forms
Injection—1 mg/mL (as base)
Dosages
Individualize infusion rate based on response.
Adults
Restoration of BP in acute hypotensive states: Add 4 mL of the solution (1 mg/mL) to 1,000 mL of 5% dextrose solution for a concentration of 4 mcg base/mL. Initially, give 8–12 mcg base per min IV. Adjust dose gradually to maintain desired BP (usually 80–100 mm Hg systolic). Average maintenance dose is 2–4 mcg base/min. Occasionally enormous daily doses are needed (68 mg base/day). Continue the infusion until adequate BP and tissue perfusion are maintained without therapy. Treatment may be required up to 6 days (vascular collapse due to acute MI). Reduce infusion gradually.
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