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Noradrenaline (Norepinephrine) Intravenous Infusion for Adults
Who can administer
Administration RESTRICTED - see Appendix 1
Important information
- For administration in specialist units only - Intensive care, high dependency, coronary care, CTICU, ED resus
- For Central line administration only
- Doses given are in terms of noradrenaline BASE
- For Y-site compatibility see below
Available preparations
Noradrenaline 0.08mg/ml solution for infusion (4mg base in 50ml)
Other strengths also may be available - see Further Information
Reconstitution
- Noradrenaline 0.08mg/ml solution for infusion: Already in solution
- Ampoules (only) to be diluted further prior to administration (generally only used when the pre-made solution is unavailable, or when higher concentrations are required) (see Further Information re ampoules)
- Use a 5 micron filter needle when drawing up contents of ampoule
Infusion fluids
Glucose 5%
Methods of intravenous administration
Continuous intravenous infusion (administer using an electronically controlled infusion device)
CENTRAL LINE administration ONLY
- 4mg BASE (=4ml of 1:1000 solution) in 50ml
- Administer at a suitable rate, titrated to pressor effect observed - see under 'dose'
- Higher concentrations may occasionally be used- see under Further Information
Dose in adults
Continuous intravenous infusion (ICU, HDU, CCU, CTICU only, ED resus)
- Note: 4mg base in 50ml = 80 micrograms per ml (ref 1)
There are two different ways of dosing noradrenaline (ref 2)
Important note:
- If patient is of normal to high body weight, consider using Method 1 (STANDARD APPROACH)- to avoid inadvertent overdose
- If patient is less than 50kg- consider using Method 2 (WEIGHT BASED APPROACH)
1: Method 1 (STANDARD APPROACH) - see Table 1
- Rate expressed in micrograms/minute
- Initial rate: 5 to 15 micrograms/minute, titrated to target blood pressure
- Usual dose range: 2 to 80 micrograms/minute. Higher doses may be required.
- Do not stop infusion suddenly as abrupt withdrawal can result in acute hypotension
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Table 1 (STANDARD APPROACH) Rate (ml/hr) of a 4mg in 50ml infusion using doses in micrograms/minute |
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dosage (microgram/minute) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 15 | 20 | 25 | 30 | 40 | 60 | 80mcg/min |
| 4mg/50ml (rate in ml/hour) | 0.75 | 1.5 | 2.3 | 3 | 3.8 | 4.5 | 5.3 | 6 | 6.8 | 7.5 | 11.3 | 15 | 18.8 | 22.5 | 30 | 45 | 60 |
2: Method 2 (WEIGHT-BASED APPROACH) - see Table 2 below
- Rate expressed in micrograms/kg/minute
- Initial rate: 0.05 to 0.15 micrograms/kg/minute, titrated to target blood pressure
- Usual dose range: 0.025 to 1 microgram/kg/minute
- Do not stop infusion suddenly as abrupt withdrawal can result in acute hypotension
|
Table 2: (WEIGHT-BASED APPROACH) Rate (ml/hr) of a 4mg in 50ml infusion using doses in micrograms/KG/minute |
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|---|---|---|---|---|---|---|
| Weight of patient in 10kg increments below (rate is given in mL/hour in this table) | ||||||
| Dose (microgram/kg/min)- below | 30kg | 40kg | 50kg | 60kg | 70kg | 80kg |
| 0.025 | 0.6 | 0.8 | 0.9 | 1.1 | 1.3 | 1.5 |
| 0.05 | 1.1 | 1.5 | 1.9 | 2.3 | 2.6 | 3.0 |
| 0.1 | 2.3 | 3.0 | 3.8 | 4.5 | 5.3 | 6.0 |
| 0.15 | 3.4 | 4.5 | 5.6 | 6.8 | 7.9 | 9.0 |
| 0.2 | 4.5 | 6.0 | 7.5 | 9.0 | 10.5 | 12.0 |
| 0.25 | 5.6 | 7.5 | 9.4 | 11.3 | 13.1 | 15.0 |
| 0.3 | 6.8 | 9.0 | 11.3 | 13.5 | 15.8 | 18.0 |
| 0.35 | 7.9 | 10.5 | 13.1 | 15.8 | 18.4 | 21.0 |
| 0.4 | 9.0 | 12.0 | 15.0 | 18.0 | 21.0 | 24.0 |
| 0.45 | 10.1 | 13.5 | 16.9 | 20.3 | 23.6 | 27.0 |
| 0.5 | 11.3 | 15.0 | 18.8 | 22.5 | 26.3 | 30.0 |
| 0.55 | 12.4 | 16.5 | 20.6 | 24.8 | 28.9 | 33.0 |
| 0.6 | 13.5 | 18.0 | 22.5 | 27.0 | 31.5 | 36.0 |
| 0.65 | 14.6 | 19.5 | 24.4 | 29.3 | 34.1 | 39.0 |
Monitoring
- Monitor infusion site frequently - extravasation may cause local tissue necrosis
- Monitor blood pressure continuously
Further information
- Alternative preparations
- Noradrenaline base 2mg in 2ml ampoule (other unlicensed forms may be used during product shortages)
- Alternative concentrations
- For patients requiring high doses you may prepare a solution containing 8mg BASE (= 8ml of 1:1000 solution) in 50ml -unlicensed concentration (ref 1)
- Note: 8mg base in 50ml = 160 micrograms per ml
- If extravasation occurs, give phentolamine (into site of extravasation) 5 to 10mg in 10 to 20ml sodium chloride 0.9% (ref 2)
- The product license for the solution for infusion stipulates "adults weighing over 50kg" . However, this monograph does not limit its use in patients below this weight (ref 3)
Storage
- Store below 250C
- Do not use if solution is brown, pink or dark yellow, or it contains precipitates
References
- SPC Noradrenaline vials (Pfizer) June 2021
- SPC: Noradrenaline pre-filled solution for infusion (Aguettant) March 2020
1: Injectable medicines guide- Medusa, downloaded 01/03/2022
2: UptoDate. downloaded 01/03/2022
3: Kidd, PS. "Noradrenaline 0.08mg/ml solution for infusion: patient's weighing less than 50kg". Personal opinion. September 2022
Therapeutic classification
Vasoconstrictor sympathomimetic