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LEVOPHED Rx

Generic Name & Formulations:

Norepinephrine bitartrate 1mg/mL (equivalent of 1mg base of norepinephrine); soln for IV infusion after dilution; contains sulfites.

Company:

Pfizer Inc.

Hypotension:

Indications for: LEVOPHED

To raise blood pressure in adults with severe, acute hypotension.

Adult Dosage:

Correct hypovolemia before administration. Give by IV infusion after dilution into a large vein. Initially 0.25–0.375mL (or 8–12mcg of base) per minute; adjust flow rate to establish and maintain a low to normal BP (usually 80–100 mmHg systolic) sufficient to maintain the circulation of vital organs. Usual maintenance: 0.0625–0.125mL (or 2–4mcg of base) per minute. Withdraw gradually.

Children Dosage:

Not established.

LEVOPHED Warnings/Precautions:

Risk of tissue ischemia. Avoid in those with mesenteric or peripheral vascular thrombosis. Occlusive or thrombotic vascular disease. Prolonged or high dose infusions. Avoid abrupt cessation. Withdraw gradually by reducing infusion rate. Risk of cardiac arrhythmias esp during hypoxia or hypercarbia. Perform continuous cardiac monitoring in those with arrhythmias. Avoid extravasation. Asthma. Sulfite sensitivity. Elderly: avoid infusion into leg veins. Pregnancy. Nursing mothers.

LEVOPHED Classification:

Sympathomimetic.

LEVOPHED Interactions:

Risk of ventricular tachycardia or fibrillation with halothaned anesthetics (eg, cyclopropane, desflurane, enflurane, isoflurane, sevoflurane); monitor cardiac rhythm. Concomitant MAOIs (eg, linezolid) or tricyclic antidepressants (eg, amitriptyline, nortriptyline, protriptyline, clomipramine, desipramine, imipramine) can cause severe, prolonged hypertension; if unavoidable, monitor BP. May decrease insulin sensitivity and raise blood glucose with antidiabetic drugs; monitor and consider dose adjustment of antidiabetics.

Adverse Reactions:

Ischemic injury, bradycardia, anxiety, transient headache, respiratory difficulty, extravasation necrosis at inj site; tissue ischemia.

Metabolism:

Norepinephrine is metabolized in the liver and other tissues by a combination of reactions involving the enzymes catechol-O-methyltransferase (COMT) and MAO. The major metabolites are normetanephrine and 3- methoxyl-4-hydroxy mandelic acid (vanillylmandelic acid, VMA), both of which are inactive. Other inactive metabolites include 3-methoxy-4-hydroxyphenylglycol, 3,4-dihydroxymandelic acid, and 3,4- dihydroxyphenylglycol.

Drug Elimination:

The mean half-life of norepinephrine is approximately 2.4 min. The average metabolic clearance is 3.1 L/min.

Noradrenaline metabolites are excreted in urine primarily as sulphate conjugates and, to a lesser extent, as glucuronide conjugates. Only small quantities of norepinephrine are excreted unchanged.

How Supplied:

Single-dose vials (4mL) or ampules (4mL)—10

LEVOPHED Rx

Generic Name & Formulations:

Norepinephrine bitartrate 1mg/mL (equivalent of 1mg base of norepinephrine); soln for IV infusion after dilution; contains sulfites.

Company:

Pfizer Inc.

Select therapeutic use:

CHF and arrhythmias:

Indications for: LEVOPHED

Adjunctive treatment in cardiac arrest and profound hypotension.

Adult Dosage:

Correct blood volume depletion before administration. Give by IV infusion after dilution (contains 4mcg of base/mL) into a large vein. Initially 2mL to 3mL (or 8–12mcg of base) per minute; adjust flow rate until adequate low normal BP (usually 80–100 mmHg systolic) and maintain tissue perfusion. Usual maintenance: 0.5mL to 1mL (or 2–4mcg of base) per minute. Withdraw gradually. Titrate dose based on response: see literature.

Children Dosage:

Not recommended.

LEVOPHED Contraindications:

Hypotension due to blood volume deficits except as an emergency measure. Mesenteric or peripheral vascular thrombosis. Profound hypoxia or hypercabia. Concomitant cyclopropane and halothane anesthesia.

LEVOPHED Warnings/Precautions:

Hypertension. Monitor BP every 2 minutes initially until desirable level is obtained, then every 5 minutes if administration is continued. Avoid extravasation. Asthma. Sulfite sensitivity. Elderly (avoid infusion into leg veins). Pregnancy (Cat. C). Nursing mothers.

LEVOPHED Classification:

Sympathomimetic.

LEVOPHED Interactions:

See Contraindications. Risk of ventricular tachycardia or fibrillation with cyclopropane, halothane anesthesia. Caution with MAOIs, triptyline or imipramine antidepressants; may cause prolonged hypertension.

Adverse Reactions:

Ischemic injury, reflex bradycardia, arrhythmias, anxiety, transient headache, respiratory difficulties, extravasation necrosis, volume depletion (esp. long-term use).

How Supplied:

Ampuls (4mL)—10

Hypotension:

Indications for: LEVOPHED

To restore blood pressure control in certain acute hypotensive states (eg, pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, MI, septicemia, blood transfusion, and drug reactions).

Adult Dosage:

Correct blood volume depletion before administration. Give by IV infusion after dilution (contains 4mcg of base/mL) into a large vein. Initially 2mL to 3mL (or 8–12mcg of base) per minute; adjust flow rate until adequate low normal BP (usually 80–100 mmHg systolic) and maintain tissue perfusion. Usual maintenance: 0.5mL to 1mL (or 2–4mcg of base) per minute. Withdraw gradually. Titrate dose based on response: see literature.

Children Dosage:

Not recommended.

LEVOPHED Contraindications:

Hypotension due to blood volume deficits except as an emergency measure. Mesenteric or peripheral vascular thrombosis. Profound hypoxia or hypercabia. Concomitant cyclopropane and halothane anesthesia.

LEVOPHED Warnings/Precautions:

Hypertension. Monitor BP every 2 minutes initially until desirable level is obtained, then every 5 minutes if administration is continued. Avoid extravasation. Asthma. Sulfite sensitivity. Elderly (avoid infusion into leg veins). Pregnancy (Cat. C). Nursing mothers.

LEVOPHED Classification:

Sympathomimetic.

LEVOPHED Interactions:

See Contraindications. Risk of ventricular tachycardia or fibrillation with cyclopropane, halothane anesthesia. Caution with MAOIs, triptyline or imipramine antidepressants; may cause prolonged hypertension.

Adverse Reactions:

Ischemic injury, reflex bradycardia, arrhythmias, anxiety, transient headache, respiratory difficulties, extravasation necrosis, volume depletion (esp. long-term use).

How Supplied:

Ampuls (4mL)—10

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