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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 When Noradrenaline is no longer required, the infusion should be discontinued and at least 10ml of blood should be withdrawn from the dedicated lumen.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