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
|
Table 1 (STANDARD APPROACH)
Rate (ml/hr) of a 4mg in 50ml infusion using doses in micrograms/minute
|
| 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
|
| |
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
