Drug reference

Noradrenaline/norepinephrine

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 222, 223

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Acute hypotension [initial and on-going treatment] ▶BY INTRAVENOUS INFUSION ▶Adult: Initially 0.16–0.33 mL/minute, adjusted according to response, dose applies to a solution containing noradrenaline 40 micrograms(base)/mL only; dilute the 1 mg/mL concentrate for infusion for this solution—consult product literature On-going treatment of acute hypotension [with escalating dose requirements] ▶BY INTRAVENOUS INFUSION ▶Adult (body-weight 50 kg and above): Use the 0.08 mg/mL or 0.16 mg/mL solution for infusion (consult product literature) DOSE EQUIVALENCE AND CONVERSION ▶1 mg of noradrenaline base is equivalent to 2 mg of noradrenaline acid tartrate. Doses expressed as the base.

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Contra Indications

Hypertension

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Cautions

Coronary vascular thrombosis. diabetes mellitus. elderly. extravasation at injection site may cause necrosis. following myocardial infarction. hypercapnia. hyperthyroidism. hypoxia. mesenteric vascular thrombosis. peripheral vascular thrombosis. Prinzmetal’s variant angina. uncorrected hypovolaemia

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Prescribing And Dispensing Information

For a period of time, preparations on the UK market may be described as either noradrenaline base or noradrenaline acid tartrate; doses in the BNF are expressed as the base.

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Safety

Important Safety Information

ASSOCIATION OF NORADRENALINE/NOREPINEPHRINE 0.08 MG/ML (4 MG IN 50 ML) AND 0.16 MG/ML (8 MG IN 50 ML) SOLUTION FOR INFUSION WITH POTENTIAL RISK OF MEDICATION ERRORS Healthcare professionals should be aware of the differences in strength and presentation between noradrenaline/norepinephrine products—manufacturer advises noradrenaline 0.08 mg/mL solution for infusion and noradrenaline 0.16 mg/mL solution for infusion must not be diluted before use and should only be used for the on-going treatment of patients already established on noradrenaline therapy, whose dose requirements are clinically conﬁrmed to be escalating.

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Interactions

→Appendix 1: sympathomimetics, vasoconstrictor

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Side Effects

Acute glaucoma. anxiety. arrhythmias. asthenia. cardiomyopathy. confusion. dyspnoea. extravasation necrosis. gangrene. headache. heart failure . hypovolaemia. hypoxia. injection site necrosis. insomnia. ischaemia. myocardial contractility increased. nausea. palpitations. peripheral ischaemia. psychotic disorder. respiratory failure. tremor. urinary retention. vomiting

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Pregnancy

Manufacturer advises use if potential beneﬁt outweighs risk—may reduce placental perfusion and induce fetal bradycardia.

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Monitoring Requirements

Monitor blood pressure and rate of ﬂow frequently.

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Dose and formulations

Directions For Administration

For intravenous infusion using a solution containing noradrenaline 40 micrograms (base)/mL, manufacturer advises give continuously in Glucose 5% or Sodium Chloride and Glucose via a controlled infusion device. For administration via syringe pump, dilute 2 mg (2 mL of 1 mg/mL concentrate for infusion) noradrenaline base with 48 mL infusion ﬂuid. For administration via drip counter dilute 20 mg (20 mL of 1 mg/mL concentrate for infusion) noradrenaline base with 480 mL infusion ﬂuid; give through a central venous catheter; incompatible with alkalis.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: infusion, solution for infusion Solution for infusion ▶Noradrenaline/norepinephrine (Non-proprietary) Noradrenaline (as Noradrenaline acid tartrate) 80 microgram per 1 ml Noradrenaline (base) 4mg/50ml solution for infusion vials | 10 vial P s Noradrenaline (as Noradrenaline acid tartrate) 1 mg per 1 ml Noradrenaline (base) 4mg/4ml concentrate for solution for infusion ampoules | 10 ampoule P £58.00 Noradrenaline (base) 4mg/4ml solution for infusion ampoules | 5 ampoule P £22.00 (Hospital only) Noradrenaline (base) 2mg/2ml solution for infusion ampoules | 5 ampoule P £12.00 (Hospital only) Noradrenaline (base) 8mg/8ml concentrate for solution for infusion ampoules | 10 ampoule P £116.00 ▶Sinora (Sintetica Ltd) Noradrenaline (as Noradrenaline acid tartrate) 80 microgram per 1 ml Sinora 4mg/50ml solution for infusion vials | 1 vial P £9.97 Noradrenaline (as Noradrenaline acid tartrate) 160 microgram per 1 ml Sinora 8mg/50ml solution for infusion vials | 1 vial P £14.22

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Dose text by age group

Adult

Initially 0.16–0.33 mL/minute, adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 222

Adult (body-weight 50 kg and above)

Use the 0.08 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

PDF page 222

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Noradrenaline/norepinephrine

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 222, 223

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 222

Contra Indications

Hypertension

PDF page 222

Cautions

PDF page 222

Prescribing And Dispensing Information

For a period of time, preparations on the UK market may be described as either noradrenaline base or noradrenaline acid tartrate; doses in the BNF are expressed as the base.

PDF page 222

Safety

Important Safety Information

PDF page 222

Interactions

→Appendix 1: sympathomimetics, vasoconstrictor

PDF page 222

Side Effects

PDF page 222

Pregnancy

Manufacturer advises use if potential beneﬁt outweighs risk—may reduce placental perfusion and induce fetal bradycardia.

PDF page 222

Monitoring Requirements

Monitor blood pressure and rate of ﬂow frequently.

PDF page 222

Dose and formulations

Directions For Administration

PDF page 222

Medicinal Forms

PDF pages 222, 223

Dose text by age group

Adult

Initially 0.16–0.33 mL/minute, adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 222

Adult (body-weight 50 kg and above)

Use the 0.08 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

PDF page 222

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.