Norepinephrine
Levophed
Endogenous catecholamine, α1 > β1 agonist
Strong α1 → vasoconstriction. Mild β1 → modest inotropy. Minimal β2.
Indications
- •Septic shock (first-line)
- •Vasoplegic shock post-bypass
- •Distributive shock
- •Anesthesia-induced hypotension (refractory)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Infusion | 0.01–1 mcg/kg/min (titrated to MAP) | — |
Pharmacokinetics
Onset seconds. Duration < 5 min after infusion stop.
Hemodynamic effects
↑SVR, ↑BP, slight ↑CO. Reflex bradycardia rare.
Side effects
- !Distal ischemia (digits, mesenteric — especially with high-dose, prolonged)
- !Extravasation necrosis — treat with phentolamine
- !Reduced renal/splanchnic perfusion at high dose
Contraindications
- ×Hypovolemic shock without volume resuscitation (relative)
Clinical pearls
- ★Surviving Sepsis: NE first-line, MAP target ≥ 65.
- ★Central line preferred but a peripheral 18g + close monitoring acceptable for short courses (recent literature).
Education only — confirm against current package inserts and institutional protocols. Doses assume normal organ function unless otherwise noted.