Hypotensive emergencies

Indication for Noradrenaline

Population group: Suitable for both men and women, only adolescents (12 years - 18 years old) , adults (18 years old or older)

Noradrenaline is indicated in adults weighing over 50kg for the on-going treatment of hypotensive emergencies with escalating noradrenaline dose requirements.

For this indication, competent medicine agencies globally authorize below treatments:

Individual dosing

Route of admnistration

Intravenous

Defined daily dose

0.05 - 1.5 ug per kg of body weight

Dosage regimen

From 0.05 To 1.5 ug per kg of body weight once every day

Detailed description

Noradrenaline 0.08mg/ml solution for infusion should not be used for initiating vasopressor treatment. It may be considered for use in patients already established on noradrenaline therapy whose dose requirements are clinically confirmed to be escalating, such that Noradrenaline 0.08 mg/ml, solution for infusion may be commenced at a flow rate of 2 ml/hr.

Noradrenaline should only be administered as an intravenous infusion via a central venous catheter to minimize the risk of extravasation and subsequent tissue necrosis. Noradrenaline (norepinephrine) 0.08 mg/ml, solution for infusion should be infused at a controlled rate using a syringe driver pump.

Noradrenaline 0.08 mg/ml, solution for infusion should not be diluted before use: it is supplied ready to use. It should not be mixed with other medicines.

Blood pressure control: Blood pressure should be monitored carefully for the duration of therapy, and preferably controlled by arterial blood pressure monitoring. The patient should be monitored carefully for the duration of noradrenaline therapy.

Posology

Initial dose

The initial dose of noradrenaline base is usually between 0.05 and 0.15 micrograms/kg/min.

Maintenance dose range

The recommended maintenance range of noradrenaline base is between 0.05 and 1.5 micrograms/kg/min.

Titration of dose

Noradrenaline (Norepinephrine) 0.08 mg/ml, solution for infusion, should be used with a suitable syringe driver pump capable of accurately and consistently delivering the minimum specified volume at a strictly controlled rate of infusion in line with the dose titration instructions.

Once an infusion of noradrenaline has been established the dose should be titrated in steps of 0.05-0.1 micrograms/kg/min of noradrenaline base according to the pressor effect observed. There is great individual variation in the dose required to attain and maintain normotension. The aim should be to establish a low normal systolic blood pressure (100-120 mmHg) or to achieve an adequate mean arterial blood pressure (greater than 65 mmHg – depending on the patient’s condition).

Manual bolus for priming when initiating an infusion is not recommended.

Caution is required during syringe relay to avoid haemodynamic instability. Continuous noradrenaline infusion through a double pump system and an extension set reducing dead-space volume should be encouraged.

Patient’s Weight (kg)Posology (µg/kg/min) noradrenaline basePosology (mg/h) noradrenaline baseInfusion rate (ml/h)
500.050.151,9
0.10.33,8
0.250.759,4
0.51.518,8
1337,5
1.54.556,3
<>600.050.182,3
0.10.364,5
0.250.911,3
0.51.822,5
13.645,0
1.55.467,5
700.050.212,6
0.10.425,3
0.251.0513,1
0.52.126,3
14.252,5
1.56.378,8
800.050.243,0
0.10.486,0
0.251.215,0
0.52.430,0
14.860,0
1.57.290,0
900.050.273,4
0.10.546,8
0.251.3516,9
0.52.733,8
15.467,5
1.58.1101,3
1000.050.33,8
0.10.67,5
0.251.518,8
0.5337,5
1675,0
1.59112,5

h: hour

Duration of Treatment

Noradrenaline 0.08mg/ml, solution for infusion should be continued until high-dose vasoactive drug support is no longer indicated, at which point, the infusion should be gradually decreased, then switched to an infusion of lower concentration. Abrupt withdrawal can result in acute hypotension.

Active ingredient

Noradrenaline provides a strong stimulation of alpha receptors in blood vessels at which these are counter-extracted. Noradrenaline also has an effect on beta-1 receptors in the heart leading to a positive inotropic and initially positive chronotropic effect. The increase in blood pressure may cause a reflex reduction in heart rate.

Read more about Noradrenaline

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