Download Sample technical information leaflet: Noradrenaline

NHS PASA Purchasing for safety project – Manchester pilot
Sample technical information leaflet: Noradrenaline
Noradrenaline (Norepinephrine) 4mg/4ml
Presentation of Vial
Noradrenaline (Norepinephrine) 1:1000 is supplied in ampoules of 4mls. Each 1ml of clear solution
contains 1mg of Noradrenaline.
Licensed Indications
Noradrenaline is used to increase blood pressure in emergency situations where a patient’s blood
pressure has fallen dangerously low.
Additional ICU Indications
As above.
Route and Method of Administration
Noradrenaline MUST be administered in a DILUTED solution via central venous catheter. Ideally a
dedicated lumen should be used. The infusion should be at a controlled rate using a syringe driver.
Standard Dose
An initial concentration of 4mg of Noradrenaline made up to a total volume of 50ml, should be
administered and tritrated according to response. The aim should be to attain and maintain an adequate
blood pressure for the patient that is being treated. Once a rate of 10ml/hr has been reached,
consideration should be given to increasing the concentration of the drug. 4mg, 8mg, 16mg, 32mg of
Noradrenaline 1:1000 can be used in a total volume of 50ml of Glucose 5%.
Compatibility
(only recommended if short of access and no alternative available)
Adrenaline, Amioderone, Calcium Salts, Dobutamine, Dopamine, Gentamicin, Heparin, Insulin (soluble),
Isoprenaline, Lidocaine, Magnesium Sulphate, Potassium Chloride.
Incompatibility
Alkaline solutions, Aminophylline, Chlorphenamine, Frusemide, Phenytoin, Sodium Bicarbonate,
Thiopental.
Instructions for Preparation
Noradrenaline should be DILUTED with Dextrose 5%.
Chloride 0.9%.
Contraindications
Loss of potency occurs if diluent is Sodium
NHS PASA Purchasing for safety project – Manchester pilot
Hypertension, Pregnancy
Special precautions

Noradrenaline should NEVER be administered as a BOLUS DOSE.

A “piggyback” syringe of Noradrenaline should be in place and attached via a 3-way tap, to ensure
a smooth transition during syringe changes.

When Noradrenaline is no longer required, the infusion should be discontinued and at least 10ml
of blood should be withdrawn from the dedicated lumen.

A Sodium Chloride flush should then be administered to maintain the patency of the lumen for
further use.
Side Effects
Hypertension, headache, bradycardia, arrhythmias, peripheral ischaemia.
Monitoring
Continuous ECG, Blood Pressure and CVP recordings.
Pharmaceutical / Handling Precautions
Do not store above 25 degrees Celsius. The solution should NOT be used if it is BROWN in colour.
References
1. SPC Noradrenaline at http://www.medicines.org.uk/ accessed 31.01.08
2. UCL Injectable Medicines Administration Guide 2 nd edition. UCL Hospitals 2007
3. Handbook of Drugs in Intensive care 3rd edition 2006
4. BNF 54