Norepinephrine Drip Composition
Standard norepinephrine drip composition is 4 mg of norepinephrine added to 250 mL of D5W (dextrose 5% in water), yielding a concentration of 16 μg/mL. 1
Standard Preparation Methods
Adult Concentrations
- Primary formulation: Add 4 mg norepinephrine to 250 mL D5W to create 16 μg/mL concentration 1
- Alternative formulation: Add 1 mg norepinephrine to 250 mL D5W to create 4 μg/mL concentration 2
- For anaphylaxis: Add 1 mg norepinephrine to 100 mL saline to create a 1:100,000 solution (10 μg/mL), administered at 30-100 mL/h 1
Diluent Options
Both D5W and normal saline (0.9% NaCl) are acceptable diluents, with equivalent chemical stability for up to 7 days at room temperature under ambient light. 2 The FDA-approved formulation uses sterile aqueous solution with sodium chloride for isotonicity and sodium metabisulfite (≤0.2 mg/mL) as an antioxidant, with pH 3.0-4.5. 3
Pediatric Preparation
"Rule of 6" method: Multiply 0.6 × body weight (kg) = number of milligrams of norepinephrine to dilute to total 100 mL saline; then 1 mL/h delivers 0.1 mcg/kg/min. 1 This simplifies bedside calculations and reduces dosing errors in pediatric populations.
Dosing Ranges by Indication
Septic Shock
- Initial rate: 0.1-0.5 mcg/kg/min (7-35 mcg/min in 70 kg adult) 4
- Typical range: 0.1-2 mcg/kg/min 5
- Target MAP ≥65 mmHg 1, 4
Cardiogenic Shock
Anaphylaxis (Refractory)
- Rate: 30-100 mL/h of 1:100,000 solution (5-15 mcg/min) 1
- Only after epinephrine and volume resuscitation have failed 1
Administration Considerations
Central venous access is strongly preferred to minimize extravasation risk and tissue necrosis. 1, 4 If central access is unavailable, peripheral IV or intraosseous routes can be used temporarily with strict monitoring protocols. 1
Critical Precautions
- Never mix with alkaline solutions (e.g., sodium bicarbonate) as norepinephrine is inactivated in alkaline pH 4
- Address hypovolemia first: Administer minimum 30 mL/kg crystalloid boluses before or concurrent with vasopressor initiation 1
- Extravasation management: Infiltrate phentolamine 5-10 mg diluted in 10-15 mL saline intradermally at site immediately (pediatric dose: 0.1-0.2 mg/kg up to 10 mg) 1, 4
Stability Data
Both 4 μg/mL and 16 μg/mL concentrations in D5W or normal saline maintain >95% potency for 7 days at room temperature under ambient light, with no significant degradation. 2 This allows for batch preparation and extended use of prepared infusions in clinical settings.