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NOREPINEPHRINE BITARTRATE is a brand name for Norepinephrine (also known as Noradrenaline), supplied as a solution. The medicine, its uses, side effects and dosage are the same regardless of brand.
Verbatim from this product's HC label. Tap a section to expand.
All parenteral preparations should be inspected visually to the extent possible for the presence of observable foreign and particulate matter, clarity, precipitate, discoloration and leakage prior to administration. The injection is not to be used if its color is pinkish or darker than slightly yellow or if it contains a precipitate.
Restoration of Blood Pressure in Acute Hypotensive States Blood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, Norepinephrine Bitartrate Injection) can be administered before and concurrently with blood volume replacement.
Diluent:
Norepinephrine Bitartrate Injection solution should be administered in 5 % dextrose solution in distilled water or 5 % dextrose in saline solution. These fluids containing dextrose are protection against significant loss of potency due to oxidation.
Administration in saline solution alone is not recommended. Whole blood or plasma, if indicated to increase blood volume, should be administered separately (for example by use of a Y-tube and individual flasks if given simultaneously).
Average Dosage:
Add 4 mL of Norepinephrine Bitartrate Injection (1 mg/mL) solution to 1000 mL of 5 % dextrose solution in distilled water or 5% dextrose in saline solution Each 1 mL of this dilution contains 4 mcg of Norepinephrine Bitartrate Injection base.
Give this dilution intravenously. Insert a plastic intravenous catheter through a suitable bore needle well advanced centrally into the vein and securely fixed with adhesive tape, avoiding if possible, a catheter tie-in technique as this promotes stasis.
A drip bulb is necessary to permit an accurate estimation of the rate of flow in drops per minute. After observing the response to an initial dose of 2 to 3 mL (from 8 to 12 mcg ofnorepinephrine) per minute, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 to 100 mm Hg systolic) sufficient to maintain the circulation to vital organs, in previously hypertensive patients, it is recommended that the blood pressure should be raised no higher than 40 mm Hg below the pre-existing systolic pressure.
5 to 1 mL (2 to 4 mcg of norepinephrine per minute). Prescribing Information - Norepinephrine Bitartrate Injection Page 9 of 11 High Dosage: Great individual variation occurs in the dose required to attain and maintain adequate blood pressure.
In all cases, dosage of Norepinephrine Bitartrate Injection should be titrated according to response of the patient. Occasionally much larger or even enormous daily doses (as high as 68 mg norepinephrine base) may be necessary if the patient remains hypotensive, but occult blood volume depletion should always be suspected and corrected when present.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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Central venous pressure monitoring is usually helpful in detecting and treating this situation.
Fluid Intake:
The degree of dilution depends on clinical fluid volume requirements. If large volumes of fluid (dextrose) are needed at a flow rate that would involve an excessive dose of the pressor agent per unit of time, a more dilute solution than 4 mcg per mL should be used.
On the other hand, when large volumes of fluid are clinically undesirable, a concentration greater than 4 mcg per mL may be used.
Duration of Therapy:
The infusion should be continued until adequate blood pressure and tissue perfusion are maintained without therapy. Norepinephrine Bitartrate Injection infusion should be reduced gradually, avoiding abrupt withdrawal. In some of the reported cases of vascular collapse due to acute myocardial infarction, treatment was required for up to six days.
Adjunctive Treatment in Cardiac Arrest Norepinephrine Bitartrate Injection is usually administered intravenously during cardiac resuscitation to restore and maintain an adequate blood pressure after an effective heartbeat and ventilation have been established by other means.
) Average Dosage: To maintain systemic blood pressure during the management of cardiac arrest. Norepinephrine Bitartrate Injection is used in the same manner as described under Restoration of Blood Pressure in Acute Hypotensive States.
Prescribing Information - Norepinephrine Bitartrate Injection Page 10 of