Download Noradrenaline (Norepinephrine)

Paediatric Critical Care Unit
Pharmacopoeia
Noradrenaline (Norepinephrine)
Presentation:
Indications:
Injection 1 in 1,000 (1mg/mL of Noradrenaline Base), 4 mL ampoules
• Persistent hypotension after initial fluid resuscitation.
• Shock secondary to excessive vasodilation.
N.B All doses Refer to Noradrenaline Base.
Dose:
Initially 0.02 - 0.1 micrograms/kg/minute, increasing as needed up to a usual maximum
of 1 micrograms/kg/minute. Higher rates may occasionally be necessary: this should
only be with consultant approval.
Route of
Administration:
Intravenous Infusion, VIA CENTRAL LINE ONLY. Can also be given via the Intraosseus
route.
Directions for I.V.
Administration:
Cautions and
Contraindications:
Common Side
Effects:
Amount of drug
to be added to
50 mL syringe
0.3mg x body
weight (kg)
1 mL/hr =
Dose range
0.1
0.02 to 1
micrograms/kg/minute micrograms/kg/minute
(but see notes above).
Concomitant use of digoxin and tricyclic antidepressants increases susceptibility to
arrhythmias. Enhanced hypertensive effect if given with tricyclic antidepressants,
clonidine and/or beta-blockers. Use with caution in vascular thrombosis (e.g.
coronary, mesenteric or peripheral), hyperthyroidism, diabetes mellitus, hypoxia or
hypercapnia. Risk of tissue necrosis on extravasation. Acidosis may reduce
effectiveness.
Hypertension, bradycardia, tachycardia, hypoxia, arrhythmias, nausea, vomitting,
tremor, urinary retention, confusion, angle-closure glaucoma and peripheral
ischaemia (including gangrene of extremities). Overdose may result in severe
hypertension, reflex bradycardia, marked increase in peripheral vascular resistance and
decreased cardiac output. Prolonged administration may lead to plasma volume
depletion.
Compatible
Incompatible
4
Compatibility
(Y – site):
Dilute to
50 mL with
either:
5% glucose
10% glucose7
0.9% saline
Acetylcysteine
4, 5
Adrenaline
4,6
Atracurium
6
Calcium Chloride
6
Calcium Gluconate
4, 5
Clonidine
4, 5
Dobutamine
4, 5
Dopamine
5
Esmolol
4, 5
Fentanyl
4, 5
Glyceryl trinitrate
4, 5
Heparin
4, 5
Labetalol
4, 5
Midazolam
5
Milrinone
4, 5
Morphine
4, 5
Potassium chloride
5
Propofol
4, 5
Remifentanil
4
Rocuronium
Sodium
4, 5
nitroprusside
5
Vasopressin
4
Aminophylline
4, 5
Insulin
6
Sodium Bicarbonate
6
Thiopental
Clearance of drug is not affected by renal function.
Continuous haemodynamic monitoring should be performed during treatment
(unless this is not possible due to technical reasons), and frequent assessment
of limb perfusion is also required.
Additional
Comments:
Some preparations contain sodium metabisulphate, which can cause
anaphylaxis and severe bronchospasm (more likely in patients with asthma).
Discard solution if discoloured or cloudy.
2mg of Noradrenaline Acid Tartrate is Equivalent to 1mg of noradrenaline base.
Version 2, May 2015, Review May 2017
Checked: Andrew Wignell, PICU Pharmacist/Amy-Jo Hooley, Paediatric Pharmacist.
Approved: PICU Consultants.
Paediatric Critical Care Unit
Pharmacopoeia
References
1.
2.
3.
4.
5.
nd
Medicines for Children, 2 Edition, 2003.
BNF for Children, 2014-2015.
th
Guy’s and Thomas’ Paediatric Formulary, 9 Edition, 2010.
nd
University College Hospitals Injectable Medicines Administration Guide, 2 Edition, 2007.
Trissel LA (ed), Handbook on Injectable Drugs. [online] London: Pharmaceutical Press accessed
via www.medicinescomplete.com (accessed on 09/01/2015).
6. Medusa Injectable Medicines Guide: accessed via http://medusa.wales.nhs.uk/ (accessed on
09/01/2015).
th
7. Northern Neonatal Formulary, 6 Edition, 2011.
Version 2, May 2015, Review May 2017
Checked: Andrew Wignell, PICU Pharmacist/Amy-Jo Hooley, Paediatric Pharmacist.
Approved: PICU Consultants.