NOREPINEPHRINE tartrate = NEP = NORADRENALINE tartrate injectable

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    Last updated: September 2023

     

    Prescription under medical supervision

     

     
     
    This drug should only be used by well trained personnel in well-equipped hospitals.

     

    Therapeutic action    

    • Sympathomimetic

    Indications

    • Acute hypotension despite fluid therapy in shock (in children, preferably use epinephrine for this indication)

    Forms and strengths, route of administration

    • 8 mg of norepinephrine tartrate in 4 ml ampoule (2 mg/ml), equivalent to 4 mg of norepinephrine base in 4 ml (1 mg/ml), for IV infusion 

    Dosage 

    The doses are expressed as norepinephrine tartrate and intended for peripheral IV administration only.

    • Use diluted solution in 0.9% sodium chloride (NaCl 0.9%) or 5% glucose (G5%) or Ringer lactate (RL):
      • Child under 40 kg: add 1 ml (2 mg of NEP tartrate) to 39 ml of NaCl 0.9%, G5% or RL to obtain a 0.05 mg/ml (50 micrograms/ml) solution
      • Child 40 kg and over and adult: add 2 ml (4 mg of NEP tartrate) to 38 ml of NaCl 0.9%, G5% or RL to obtain a 0.1 mg/ml (100 micrograms/ml) solution
    • Administer by continuous IV infusion using an infusion or syringe pump:
      • Child and adult: 0.1 microgram/kg/min, increase if necessary by 0.05 micrograms/kg/min every 10 minutes for the first hour, then every hour (max. 1 microgram/kg/min)

      • Once desired response is achieved, discontinue gradually, in decrements of 0.05 micrograms/kg/min every hour. Do not discontinue abruptly.

    • The infusion rate is calculated as follows: [desired dose (microgram/kg/min) x weight (kg) x 60 min] ÷ concentration (microgram/ml).

    Example, for a child 20 kg, dose 0.1 microgram/kg/min, solution concentration 50 micrograms/ml:

    NEP dose (microgram/kg/min)

    0.1

    0.15

    0.2

    0.25

    0.3

    0.35

    0.4

    0.45

    0.5

    Infusion rate (ml/hour)

    2.4

    3.6

    4.8

    6

    7.2

    8.4

    9.6

    10.8

    12

     

    Contra-indications, adverse effects, precautions

    • Administer with caution to patients with hypertension, hypotension due to volume depletion (except as an emergency measure), thrombosis, hyperthyroidism and to older patients.

    • May cause: arrhythmia, hypertension, agitation, headache; tissue necrosis following extravasation (use a large vein for IV administration).

    • Pregnancy and breast-feeding: no contra-indication

    Remarks

    • Norepinephrine is colourless: discard any ampoules with a pink or brownish colour.

    Storage     

     
    –  Below 25 °C
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