Indications
Noradrenaline (also called norepinephrine) is an emergency hospital medicine used to raise and maintain blood pressure in people with severe low blood pressure (shock), for example in septic shock, after a heart attack or during surgery and anaesthesia. It is also used as part of resuscitation after cardiac arrest.
How It Works
Noradrenaline is a natural hormone and nerve messenger. As a medicine it mainly stimulates alpha-adrenergic receptors on blood vessels, making them narrow (constrict), which raises blood pressure. It also has some effect on beta-1 receptors in the heart, helping the heart pump more strongly. This helps keep blood flowing to vital organs such as the brain, heart and kidneys.
Dosage and Administration
Noradrenaline is given only by a doctor or nurse in hospital, usually in an intensive care unit or operating theatre. It is diluted and given as a continuous infusion into a vein, preferably a large central vein, using an infusion pump. The dose is adjusted minute to minute according to blood pressure and the patient’s response, as prescribed. It is stopped gradually, not suddenly.
Interactions
- MAO inhibitors, tricyclic antidepressants (such as Amitriptyline) and Linezolid can greatly increase its effect on blood pressure.
- Some anaesthetic gases (such as Halothane) increase the risk of heart rhythm problems.
- Beta blockers, other vasopressors, Oxytocin and ergot medicines can change the blood pressure response.
- The care team will review all medicines given at the same time.
Contraindications
- Low blood pressure due to low blood volume (for example from bleeding or dehydration) before the volume has been replaced, except as a short emergency measure.
- Blood clots blocking the blood supply to the limbs or gut, unless life-saving.
- Allergy to noradrenaline or any ingredient (some products contain sulfites).
Side Effects
Possible effects include headache, anxiety, slow or irregular heartbeat, very high blood pressure, breathing difficulty, and reduced blood flow to fingers, toes, kidneys or gut. If the infusion leaks out of the vein, it can cause severe tissue damage at the site.
The care team must be told at once about chest pain, severe headache, pain, coldness, colour change or swelling around the drip site, or pale, cold or blue fingers and toes. Leakage at the drip site is treated urgently, often with Phentolamine injection into the area.
Pregnancy and Lactation
Noradrenaline may reduce blood flow to the womb and the baby, so in pregnancy it is used only when the benefit to the mother is judged to outweigh the risk. It is not known whether it passes into breast milk; the doctor will advise on breastfeeding.
Precautions and Warnings
- Blood volume should be corrected before or alongside treatment.
- Blood pressure, heart rhythm, urine output and the infusion site must be monitored closely.
- Use with extra caution in people with heart disease, blood vessel disease, diabetes, overactive thyroid or older age.
- Do not use a solution that is brown or contains particles.
Overdose
Overdose causes very high blood pressure, severe headache, slow heart rate, irregular heartbeat, chest pain, vomiting and, in severe cases, bleeding in the brain or fluid on the lungs. The infusion is stopped or reduced and supportive treatment is given by the hospital team.
Therapeutic Class
Vasopressor; sympathomimetic (catecholamine).
Storage
Hospital use: store below 25°C, protected from light, in the original carton, as directed on the pack. Do not freeze.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.