Norepinephrine, also known by its trade name Levophed, is a vasoconstricting drug that raises blood pressure to treat severe hypotension, especially cases of shock. The IV site must be monitored closely, as a major side effect is tissue necrosis if the IV leaks into surrounding tissue. If leakage or extravasation does occur, this tissue damage can be reversed by the drug phentolamine.

Key Points

  • Mechanism
    • Catecholamine
    • Vasoconstrictor
      • Acts on alpha-adrenergic receptors to cause peripheral vasoconstriction
      • Vasoconstriction increases vascular resistance and increases blood pressure (mean arterial pressure)
    • Mild increase in cardiac output
      • Acts on beta-adrenergic receptors to increase heart rate and contractility
    • Clinical Use
      • Hypotension (severe)
        • Shock
          • If patient is hypovolemic, fluids and/or blood must be administered prior to norepinephrine
      • Heart failure
    • Side Effects and Adverse Reactions
      • Tissue necrosis at IV site
        • Extravasation of drug around injection site causes vasoconstriction, leading to decreased perfusion
        • Can lead to local skin death around IV site
          • Monitor IV site closely
          • Infuse through a central line when possible.
          • Phentolamine can be used to reduce tissue damage if extravasation occurs
      • Myocardial ischemia
        • May result from vasoconstriction at coronary arteries
      • May cause reflex bradycardia
        • Sudden increases in blood pressure by way of vasoconstriction can lead to baroreceptor-mediated slowing of the heart
      • Dysrhythmias