From the FDA Drug Label
Average Dosage: Add the content of the vial (4 mg/4 mL) of LEVOPHED to 1,000 mL of a 5 percent dextrose containing solution. Each mL of this dilution contains 4 mcg of the base of LEVOPHED High Dosage: Great individual variation occurs in the dose required to attain and maintain an adequate blood pressure. In all cases, dosage of LEVOPHED should be titrated according to the response of the patient Occasionally much larger or even enormous daily doses (as high as 68 mg base or 17 vials) may be necessary if the patient remains hypotensive, but occult blood volume depletion should always be suspected and corrected when present.
The maximum dose of LEVOPHED is not strictly defined, but enormous daily doses (as high as 68 mg base or 17 vials) may be necessary in some cases 1.
From the Research
The maximum dose of levophed (norepinephrine) is typically 3 mcg/kg/min, though there is no absolute maximum dose in life-threatening situations. Start with 0.1-0.5 mcg/kg/min and titrate to achieve the desired blood pressure, usually a mean arterial pressure (MAP) of 65-70 mmHg. Levophed should be administered through a central venous catheter as a continuous infusion, diluted in D5W or normal saline. Close monitoring is essential, including frequent blood pressure checks, heart rate, urine output, and peripheral perfusion. Higher doses increase the risk of adverse effects such as arrhythmias, tissue ischemia, and end-organ damage. Levophed works by stimulating alpha-adrenergic receptors to cause vasoconstriction, increasing blood pressure in shock states. The dose should be gradually reduced once hemodynamic stability is achieved to minimize potential complications from prolonged use.
Key Considerations
- The provided evidence does not directly address the maximum dose of levophed, but it discusses the use of norepinephrine in various shock states, including septic shock and out-of-hospital cardiac arrest 2, 3, 4, 5, 6.
- The most recent and highest quality study, which is a retrospective observational study published in 2025, compares the survival outcomes between norepinephrine plus epinephrine and norepinephrine plus vasopressin after return of spontaneous circulation in patients with out-of-hospital cardiac arrest 2.
- However, none of the provided studies directly answer the question about the maximum dose of levophed, so the answer is based on general medical knowledge and standard practices in critical care medicine.
- It is essential to note that the dose of levophed should be individualized and titrated to achieve the desired blood pressure while minimizing the risk of adverse effects.
Monitoring and Titration
- Close monitoring of blood pressure, heart rate, urine output, and peripheral perfusion is crucial when administering levophed.
- The dose should be titrated to achieve a mean arterial pressure (MAP) of 65-70 mmHg, and the infusion rate should be adjusted accordingly.
- Higher doses increase the risk of adverse effects, so it is essential to use the lowest effective dose and to gradually reduce the dose once hemodynamic stability is achieved.