General recommendations
Enter only intravenously.
Individual dose of Norepinephrine is established by a doctor depending on the clinical condition of the patient.
Norepinephrine must be administered through central venous access devices, in order to reduce the risk of extravasation and subsequent necrosis (see section "Special instructions").
Before or during therapy, correction of hypovolemia, hypoxia,acidosis, hypercapnia.
Administration of the drug
Recommended initial dose and rate of drug administration - 0.1 to 0.3 μg / kg / min of norepinephrine bitartrate. The infusion rate is progressively increased by titration step-by-step, at 0.05-0.1 μg / kg / min, according to the observed pressor effect until the desired normotonia is achieved.
There are individual differences in the dose necessary to achieve and maintain normotonia. The goal is to reach the lower limit of the norm of systolic pressure (100-120 mm Hg, depending on the patient's condition). The individual dose, due to the high variability of the clinical response when the drug is administered, is established depending on the patient's condition.
Norepinephrine should be used concurrently with proper replenishment of circulating blood volume.
It is necessary to guard against the introduction of a solution of norepinephrine under the skin and in the muscles because of the danger of developing necrosis.
Dilution of concentrate
Concentrate should be diluted in a 5% solution of dextrose. Do not mix with other drugs.
- for injection with a syringe infusion pump - to 2 ml of concentrate to prepare a solution for intravenous administration of the drug Norepinephrine, 2 mg / ml, 48 ml of a 5% solution of dextrose are added.
- for administration with a dropper - to 20 ml of concentrate to prepare a solution for intravenous administration of the drug Norepinephrine, 2 mg / ml, 480 ml of dextrose solution are added.
In both dilutions, the final concentration of the resulting solution for intravenous administration is 0.08 mg / ml norepinephrine bitartrate, which corresponds to 0.04 mg / ml norepinephrine base.
After diluting the concentrate, the solution should be used within 12 hours.
Volume of injected liquid: the level of dilution depends on the patient's condition. If a large volume of fluid is required, the preparation should be diluted with a large amount of dextrose and thus use a preparation with a lower concentration for administration. In the case of undesirability of introducing a large volume of liquid, the concentrate is diluted with a smaller volume of dextrose, resulting in a more concentrated solution.
To determine the rate of infusion of the drug solution Norepinephrine with a concentration of 0.08 mg / ml and the corresponding amount of norepinephrine bitartrate, you can use the data in the table:
Table Calculation of the infusion rate (mL / h) of the drug solution Norepinephrine with a concentration of 0.08 mg / ml *
| Patient weight | Dosage of norepinephrine bitartrate (μg / kg / min) | The amount of norepinephrine bitartrate (mg / h) | Infusion rate (ml / h) |
| 50 kg | 0,05 | 0,15 | 1,875 |
| 0,1 | 0,3 | 3,75 |
| 0,2 | 0,6 | 7,5 |
| 0,3 | 0,9 | 11,25 |
| 0,5 | 1,5 | 18,75 |
| 1 | 3 | 37,5 |
| 2 | 6 | 75 |
| 60 kg | 0,05 | 0,18 | 2,25 |
| 0,1 | 0,36 | 4,5 |
| 0,2 | 0,72 | 9 |
| 0,3 | 1,08 | 13,5 |
| 0,5 | 1,8 | 22,5 |
| 1 | 3,6 | 45 |
| 2 | 7,2 | 90 |
| 70 kg | 0,05 | 0,21 | 2,625 |
| 0,1 | 0,42 | 5,25 |
| 0,2 | 0,84 | 10,5 |
| 0,3 | 1,26 | 15,75 |
| 0,5 | 2,1 | 26,25 |
| 1 | 4,2 | 52,5 |
| 2 | 8,4 | 105 |
| 80 kg | 0,05 | 0,24 | 3 |
| 0,1 | 0,48 | 6 |
| 0,2 | 0,96 | 12 |
| 0,3 | 1,44 | 18 |
| 0,5 | 2,4 | 30 |
| 1 | 4,8 | 60 |
| 2 | 9,6 | 120 |
* If using another concentrate dilution, you should replace the solution concentration in the formula used:
Infusion rate (ml / h) = dosage (μg / kg / min) x patient weight (kg) x 60 (min) x 0.001 / 0.08 mg / ml
Arterial pressure:
The duration, rate of administration and dosing of the solution of Norepinephrine are determined by cardiac monitoring data with compulsory medical monitoring of blood pressure (every 2 minutes until normotonia, after every 5 minutes during the entire infusion) to avoid the onset of hypertension.
Discontinuation of therapy:
Therapy with norepinephrine should be reduced in stages, as abrupt reversal can lead to acute hypertension.
The course of treatment can last from several hours to 6 days.