Noradrenaline (Norepinephrine) Infusion Pump Dosage
The recommended standard dosage for noradrenaline infusion is an initial dose of 8 to 12 mcg per minute intravenously, followed by a typical maintenance dose of 2 to 4 mcg per minute, with careful titration based on patient response and blood pressure monitoring. 1
Preparation and Administration
Standard Dilution
- Add 4 mg (4 mL) of noradrenaline to 1,000 mL of 5% Dextrose Injection or Sodium Chloride Injection containing 5% dextrose to produce a 4 mcg/mL solution 1
- Dextrose is important as it reduces potency loss due to oxidation
- Administration in saline solution alone is not recommended
Administration Guidelines
- Always correct hypovolemia before initiating noradrenaline therapy
- Infuse into a large vein (avoid leg veins in elderly or patients with occlusive vascular disease)
- Monitor blood pressure every 2 minutes until desired effect is achieved, then every 5 minutes for the duration of infusion
- When discontinuing, reduce flow rate gradually to avoid abrupt withdrawal
Dosing Protocol
Initial Dosing
- Start with 8-12 mcg/minute IV infusion 1
- Assess patient response and adjust accordingly
Maintenance Dosing
- Typical maintenance dose: 2-4 mcg/minute 1
- Titrate to maintain desired hemodynamic effect
Weight-Based Dosing Alternative
For more precise dosing, especially in critical care settings:
- 0.1-0.5 mcg/kg/minute (for a 70 kg adult, this equals 7-35 mcg/minute) 2
Special Considerations
Infusion System Recommendations
- Double syringe pump systems with very low dead-space volume infusion sets appear most appropriate for noradrenaline administration 3
- This configuration allows for more rapid achievement of target mean arterial pressure compared to single pump systems
Storage and Stability
- Diluted noradrenaline solution can be stored for up to 24 hours at room temperature (20-25°C)
- Protect from light 1
Drug Incompatibilities
- Avoid contact with iron salts, alkalis, or oxidizing agents
- If blood or plasma administration is needed, administer separately 1
Safety Precautions
Avoiding Medication Errors
- Be cautious when programming infusion pumps to prevent inadvertent overinfusion 4
- Verify pump settings, especially when using loading dose options
- Double-check concentration calculations and flow rates
Monitoring Requirements
- Continuous blood pressure monitoring is essential
- Target MAP >65 mmHg in most clinical scenarios
- Monitor for signs of extravasation (tissue necrosis can occur)
Extravasation Management
- If extravasation develops, infiltrate 5-10 mg of phentolamine diluted in 10-15 mL of saline into the site as soon as possible to prevent tissue death 2
By following these guidelines, noradrenaline infusion can be safely and effectively administered to maintain adequate tissue perfusion in patients requiring vasopressor support.