From the Guidelines
Norepinephrine is the recommended first-line vasopressor for the treatment of hypotension in critically ill patients, particularly those with septic shock, due to its ability to provide reliable blood pressure support with fewer arrhythmogenic effects and less tachycardia, as evidenced by the Surviving Sepsis Campaign guidelines 1. The typical starting dose of norepinephrine is 0.1-0.5 mcg/kg/min administered as a continuous intravenous infusion, titrated to maintain a mean arterial pressure (MAP) of 65-75 mmHg. Norepinephrine works by stimulating alpha-1 adrenergic receptors in blood vessels, causing vasoconstriction and increasing blood pressure. It also has modest beta-1 adrenergic effects, providing some increase in cardiac contractility without significantly increasing heart rate. Some key points to consider when administering norepinephrine include:
- Administration through a central venous catheter to prevent tissue damage from extravasation
- Continuous blood pressure monitoring
- Potential side effects, such as hypertension if dosed too high, reflex bradycardia, and decreased perfusion to extremities
- Preference over dopamine in most shock states due to its more reliable blood pressure support and fewer arrhythmogenic effects, as supported by studies comparing norepinephrine and dopamine in septic shock patients 1. Additionally, the use of norepinephrine has been associated with improved outcomes in septic shock patients, and its efficacy has been demonstrated in various studies, including a global perspective on vasoactive agents in shock 1 and guidelines for the management of intra-abdominal infections 1.
From the FDA Drug Label
DESCRIPTION Norepinephrine (sometimes referred to as l-arterenol/Levarterenol or l-norepinephrine) is a sympathomimetic amine which differs from epinephrine by the absence of a methyl group on the nitrogen atom The question about Norepinephrine is not specific, and the provided text from the drug label does not directly answer any particular question about the drug.
- The drug label provides information about the description, description of the compound, and formulation of norepinephrine 2. The FDA drug label does not answer the question.
From the Research
Norepinephrine Use in Septic Shock
- Norepinephrine is recommended as the first-line vasopressor in septic shock due to its ability to correct hypotension caused by depressed vascular tone 3, 4, 5.
- The use of norepinephrine in septic shock has been associated with several benefits, including:
- The optimal timing for initiating norepinephrine in septic shock is still a topic of debate, but recent studies suggest that early administration may be beneficial 4, 6, 7.
- The target mean arterial pressure (MAP) for norepinephrine use in septic shock is typically around 65 mmHg, although this may vary depending on individual patient factors 4, 7.
Comparison with Other Vasopressors
- Norepinephrine has been compared to other vasopressors, such as dopamine, epinephrine, and vasopressin, in several studies 5, 6.
- These studies have generally found that norepinephrine is associated with improved outcomes, including reduced mortality and fewer adverse events, compared to other vasopressors 5, 6.
- However, the evidence is not always consistent, and further studies are needed to fully understand the relative benefits and risks of different vasopressors in septic shock 6.
Clinical Trials and Studies
- Several clinical trials and studies have investigated the use of norepinephrine in septic shock, including the CENSER trial 7.
- These studies have provided valuable insights into the effectiveness and safety of norepinephrine in this context, and have helped to inform clinical practice guidelines 3, 4, 5, 6, 7.