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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Levophed(r) Norepinephrine Bitartrate
Brand Name
Levophed(r) Norepinephrine Bitartrate
Generic Name
Levophed(r) Norepinephrine Bitartrate
Active Ingredient
Norepinephrine BitartrateCategory
Vitamin C [EPC]
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 1 mg/mL | INJECTION, SOLUTION, CONCENTRATE | INTRAVENOUS | 51662-1315 |
Detailed information about Levophed(r) Norepinephrine Bitartrate
References used for this content
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Levophed(r) Norepinephrine Bitartrate, you must consult a qualified healthcare professional.
Norepinephrine Bitartrate is a potent catecholamine and sympathomimetic amine used primarily in the emergency treatment of acute hypotension and shock. It functions as a powerful peripheral vasoconstrictor and cardiac stimulant through alpha and beta-adrenergic receptor activation.
The dosage of Norepinephrine Bitartrate must be highly individualized and is always titrated to achieve a specific clinical goal, such as a target Mean Arterial Pressure (MAP) of ≥65 mmHg.
Norepinephrine Bitartrate is used in pediatric patients, but safety and effectiveness have not been established through large-scale controlled clinical trials. Dosing is typically weight-based.
No specific dose adjustment is required for patients with renal impairment. However, because Norepinephrine causes renal vasoconstriction, healthcare providers must monitor urine output and kidney function closely to ensure that the drug is not further compromising renal perfusion.
No formal dose adjustments are established for hepatic impairment. The drug is rapidly metabolized by COMT and MAO in various tissues, so liver failure does not significantly prolong its half-life.
Elderly patients should be started at the lower end of the dosing range. They may be more sensitive to the effects of Norepinephrine and are at a higher risk for adverse effects, such as cardiac arrhythmias or excessive vasoconstriction that can lead to limb ischemia.
Norepinephrine Bitartrate is never self-administered. It is given by a continuous intravenous infusion by trained medical personnel in a hospital setting.
Because Norepinephrine Bitartrate is given as a continuous infusion in a controlled medical environment, a missed dose is unlikely. If the infusion is interrupted, blood pressure may drop rapidly, requiring immediate medical intervention.
An overdose of Norepinephrine Bitartrate results in an exaggerated pharmacological effect.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance. This medication is managed exclusively by medical professionals.
Norepinephrine Bitartrate is a powerful medication, and its side effects are often extensions of its primary action on the cardiovascular system.
> Warning: Stop taking Norepinephrine Bitartrate and call your doctor immediately if you experience any of these.
Norepinephrine is generally intended for short-term, emergency use. However, prolonged infusion can lead to:
Norepinephrine Bitartrate carries a critical warning regarding the risk of tissue necrosis if extravasation occurs. To prevent this, the drug should be administered into a large vein, preferably through a central venous catheter. If extravasation is suspected, the area should be infiltrated as soon as possible with 10 mg to 15 mg of phentolamine (an alpha-adrenergic blocking agent) in 10 mL to 15 mL of saline solution to counteract the local vasoconstriction and prevent tissue death.
Report any unusual symptoms to your healthcare provider immediately during the infusion.
Norepinephrine Bitartrate is a high-alert medication that requires meticulous administration and monitoring. It is used only when the benefits of restoring blood pressure outweigh the risks of its potent vasoconstrictive and cardiac effects. Healthcare providers must ensure the patient is adequately hydrated before and during therapy, as using vasopressors in a volume-depleted (dehydrated) patient can cause severe organ damage.
As noted in the side effects section, the FDA-approved labeling for Norepinephrine Bitartrate includes a prominent warning regarding Extravasation. This is the most critical safety concern for healthcare providers. The warning emphasizes that the infusion site must be checked frequently for signs of leakage. Phentolamine must be readily available to treat any accidental extravasation to prevent permanent tissue damage and gangrene.
Patients receiving Norepinephrine Bitartrate require intensive, continuous monitoring:
This medication is only administered to patients who are critically ill and hospitalized. Patients receiving Norepinephrine Bitartrate are not in a condition to drive or operate machinery.
There is no direct interaction with alcohol in a clinical sense, as patients requiring this drug are in a critical state where alcohol consumption is impossible. However, chronic alcohol use can affect the cardiovascular system's response to catecholamines.
Norepinephrine Bitartrate should never be stopped suddenly. When the patient's condition improves, the infusion rate must be gradually reduced (tapered). Abrupt discontinuation can lead to a 'rebound' effect, where the blood pressure drops precipitously back to dangerous levels.
> Important: Discuss all your medical conditions with your healthcare provider before starting Norepinephrine Bitartrate, particularly any history of heart disease, asthma, or circulation problems.
Certain medications can cause life-threatening reactions when combined with Norepinephrine Bitartrate:
There are no known significant food interactions with Norepinephrine Bitartrate, as it is administered intravenously in a fasting or tube-fed critical care state. However, caffeine (a stimulant) could theoretically increase the risk of heart palpitations or high blood pressure.
Norepinephrine Bitartrate does not typically interfere with standard blood chemistry or hematology tests. However, it can significantly increase the levels of vanillylmandelic acid (VMA) and normetanephrine in the urine, which are used to test for certain tumors (like pheochromocytoma). This can lead to false-positive results for these specific tests.
For each major interaction, the management strategy involves either avoiding the combination entirely or performing extremely cautious dose titration with continuous hemodynamic monitoring.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, even those you took several days before entering the hospital.
There are very few absolute contraindications for Norepinephrine Bitartrate because it is often used as a life-saving measure. However, it should never be used in the following circumstances:
These conditions require a careful risk-benefit analysis by the healthcare team:
Patients who are allergic to other catecholamines (like epinephrine or dopamine) may also be sensitive to Norepinephrine. Additionally, the presence of sulfites in many formulations means that patients with a documented 'sulfite allergy' are at high risk for anaphylaxis.
> Important: Your healthcare provider will evaluate your complete medical history and current clinical state before prescribing Norepinephrine Bitartrate.
Norepinephrine Bitartrate is classified as FDA Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Animal studies have shown that Norepinephrine can cause fetal bradycardia and reduce uterine blood flow, which may lead to fetal hypoxia (lack of oxygen). In clinical practice, Norepinephrine is reserved for life-threatening maternal hypotension where other treatments have failed. If used, the healthcare team must monitor fetal heart rate closely.
It is not known whether Norepinephrine is excreted in human milk. However, because it is rapidly destroyed in the infant's digestive tract and has an extremely short half-life in the mother's blood, the risk to a nursing infant is likely low. Regardless, the clinical situation requiring Norepinephrine (shock) usually precludes breastfeeding.
As mentioned, safety and efficacy in children have not been established through formal trials. However, it is widely used in pediatric intensive care for septic and distributive shock. Dosing must be calculated with extreme care, usually by weight, and administered via a dedicated infusion pump to prevent accidental bolus doses.
Patients over the age of 65 are more likely to have underlying cardiovascular disease, such as coronary artery disease or peripheral vascular disease. They are at a significantly higher risk for adverse effects like arrhythmias and limb ischemia. Healthcare providers typically start with lower doses and titrate more slowly in this population.
Norepinephrine causes significant constriction of the renal arteries. In patients with pre-existing kidney disease, this can lead to a further decrease in the glomerular filtration rate (GFR). While no specific dose adjustment is needed, clinicians must monitor kidney function (creatinine and urine output) meticulously.
Because Norepinephrine is metabolized by enzymes found throughout the body (MAO and COMT) and not solely by the liver's CYP450 system, hepatic impairment does not significantly alter the drug's clearance. No specific adjustments are required based on Child-Pugh classification.
> Important: Special populations require individualized medical assessment and continuous monitoring in a critical care setting.
Norepinephrine Bitartrate is a potent sympathomimetic amine. At the molecular level, it acts as a ligand for adrenergic receptors. Its primary effect is mediated through Alpha-1 adrenergic receptors located on vascular smooth muscle cells. Binding triggers a G-protein-coupled signaling cascade that increases intracellular calcium, leading to muscle contraction and systemic vasoconstriction. It also acts on Beta-1 adrenergic receptors in the myocardium, stimulating adenylate cyclase and increasing cyclic AMP, which enhances calcium influx during action potentials. This results in increased contractility (inotropy).
The onset of action for Norepinephrine is almost immediate when given intravenously. The duration of effect is very short (1-2 minutes) once the infusion is stopped. It primarily increases systolic, diastolic, and mean arterial pressures. The effect on heart rate is variable; while it has direct stimulating effects, the rise in blood pressure often triggers a compensatory vagal reflex that can result in a net decrease in heart rate (reflex bradycardia).
| Parameter | Value |
|---|---|
| Bioavailability | N/A (Intravenous only) |
| Protein Binding | ~25% (Primarily to Albumin) |
| Half-life | 1 - 2 minutes |
| Tmax | Immediate (IV infusion) |
| Metabolism | MAO and COMT (Liver and other tissues) |
| Excretion | Renal (95% as inactive metabolites) |
Norepinephrine Bitartrate is a catecholamine and a sympathomimetic vasopressor. It is therapeutically categorized as a cardiac stimulant and vasoconstrictor. Related medications include Epinephrine, Dopamine, and Phenylephrine.
Common questions about Levophed(r) Norepinephrine Bitartrate
Norepinephrine Bitartrate is primarily used in emergency medicine to treat life-threatening low blood pressure (hypotension) and shock. It is commonly utilized in cases of septic shock, where the body's blood vessels dilate excessively due to infection. By constricting these vessels, the medication helps restore blood pressure to a level that keeps vital organs functioning. It may also be used during cardiac arrest or after major surgery to stabilize a patient's cardiovascular system. Because it is so potent, it is only administered in hospitals under constant supervision.
The most common side effects include headache, anxiety, and a slow heart rate (reflex bradycardia). Some patients may feel restless or experience a 'pounding' sensation in their chest. Because it narrows blood vessels, it can also cause the skin to look pale or feel cold. At the site of the IV injection, some irritation or pain may occur. Most of these effects are temporary and are closely managed by the medical team by adjusting the infusion rate.
Alcohol consumption is not possible while receiving Norepinephrine Bitartrate, as this medication is only given to patients in critical condition, such as those in shock or in an ICU. Clinically, alcohol can interfere with how the heart and blood vessels respond to medications like Norepinephrine. If you have a history of heavy alcohol use, it is important for your medical team to know, as it may affect how they manage your blood pressure. Once you have recovered and are discharged, you should consult your doctor before resuming alcohol use.
Norepinephrine Bitartrate is generally only used during pregnancy if it is a life-saving necessity for the mother. It is classified as FDA Category C, meaning animal studies have shown potential risks to the fetus, such as reduced oxygen delivery due to constricted uterine blood flow. However, in a situation where the mother's blood pressure is dangerously low, the medication may be required to save both the mother and the baby. Doctors will weigh the risks and benefits carefully and monitor the baby's heart rate throughout the treatment. There is no evidence that it is safe for routine use during pregnancy.
Norepinephrine Bitartrate works almost instantly when administered through an intravenous (IV) line. Most patients will show an increase in blood pressure within 30 to 60 seconds of starting the infusion. Because it works so quickly and leaves the body just as fast, doctors can make very precise adjustments to the dose to keep the blood pressure at a target level. If the infusion is stopped, the effects usually wear off completely within 1 to 2 minutes. This rapid action makes it an ideal tool for managing unstable patients in the ICU.
No, Norepinephrine Bitartrate should never be stopped abruptly. If the infusion is turned off suddenly, the patient's blood pressure can drop back down to dangerously low levels almost immediately. Instead, healthcare providers 'wean' the patient off the medication by slowly decreasing the infusion rate over several hours or days. This allows the body's own blood pressure control systems to take back over gradually. The medical team will only stop the drug once the patient can maintain a safe blood pressure on their own.
In a hospital setting, missing a dose of Norepinephrine Bitartrate is highly unlikely because it is delivered by a programmed infusion pump that sounds an alarm if the medication runs low or the line is blocked. If an interruption does occur, the medical staff will act immediately to restart the infusion and stabilize your blood pressure. Since this medication is not taken at home, patients do not need to worry about remembering doses. The ICU staff is responsible for ensuring the continuous delivery of the drug.
Norepinephrine Bitartrate does not cause long-term weight gain. It is used for short-term emergency stabilization, often for only a few days. While a patient is in the ICU receiving this drug, they may experience some swelling (edema) or weight changes due to the large amounts of IV fluids given to treat shock, but this is not a direct effect of the Norepinephrine itself. The medication does not affect appetite or fat storage in the way that some long-term medications, like steroids, might. Any weight changes during treatment are usually related to the underlying critical illness.
Norepinephrine Bitartrate has several significant interactions with other drugs, especially those that affect the heart or nervous system. For example, certain antidepressants (MAOIs and TCAs) can make Norepinephrine much more powerful, potentially causing a dangerous spike in blood pressure. Some anesthetics used in surgery can also interact with it to cause irregular heart rhythms. Because of these risks, the medical team will carefully review all of a patient's current medications before and during the infusion. They will adjust the doses of all medications to ensure they work safely together.
Yes, Norepinephrine Bitartrate is available as a generic medication and is widely used in hospitals around the world. While it was originally sold under the brand name Levophed, the generic versions are considered equally effective and are the standard of care in most medical facilities. Because it is an injectable drug used only in emergencies, it is not something you would buy at a retail pharmacy. The availability of generic forms helps ensure that this life-saving medication remains accessible for hospitals and emergency responders.
Other drugs with the same active ingredient (Norepinephrine Bitartrate)