Norepinephrine Bitartrate

Norepinephrine bitartrate injection is indicated to raise blood pressure in adult patients with severe, acute hypotension. Norepinephrine bitartrate injection is a catecholamine indicated for restoration of blood pressure in adult patients with acute hypotensive states. ( 1 )

None. None. ( 4 )

• Tissue Ischemia : Avoid extravasation of norepinephrine bitartrate into the tissues, as local necrosis might ensue due to the vasoconstrictive action of the drug. Infuse norepinephrine bitartrate into a large vein. To prevent sloughing and necrosis in areas in which extravasation has taken place, the area should be infiltrated as soon as possible with 10 mL to 15 mL of saline solution containing from 5 mg to 10 mg of an adrenergic blocking agent. ( 5.1 )
• Hypotension After Abrupt Discontinuation : Sudden cessation of the infusion rate may result in marked hypotension. Reduce the norepinephrine bitartrate infusion rate gradually. ( 5.2 )
• Cardiac Arrhythmias: Norepinephrine bitartrate may cause arrhythmias. Monitor cardiac function in patients with underlying heart disease. ( 5.3 )
• Allergic Reactions with Sulfite: Norepinephrine bitartrate contains sodium metabisulfite. Sulfite may cause allergic-type-reactions. ( 5.4 )

5.1Tissue Ischemia Administration

of norepinephrine bitartrate to patients who are hypotensive from hypovolemia can result in severe peripheral and visceral vasoconstriction, decreased renal perfusion and reduced urine output, tissue hypoxia, lactic acidosis, and reduced systemic blood flow despite “normal” blood pressure. Address hypovolemia prior to initiating norepinephrine bitartrate [see Dosage and Administration (2.1) ]. Avoid norepinephrine bitartrate in patients with mesenteric or peripheral vascular thrombosis, as this may increase ischemia and extend the area of infarction.