Standard Norepinephrine Dilution
The standard adult dilution for norepinephrine is 4 mg added to 250 mL of D5W, yielding a concentration of 16 mcg/mL. 1, 2
Standard Preparation
- Add 4 mg of norepinephrine to 250 mL of D5W to create a 16 mcg/mL concentration - this is the most commonly used standard dilution in clinical practice 1, 2
- The FDA label explicitly states: "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" - however, the 250 mL preparation (16 mcg/mL) is more practical and widely used 2
- D5W or 5% dextrose with sodium chloride are the recommended diluents, as dextrose-containing fluids protect against potency loss from oxidation 2
- Saline solution alone is NOT recommended as the primary diluent due to oxidation concerns 2
Alternative Concentrations
- For anaphylaxis: 1 mg norepinephrine in 100 mL saline creates a 1:100,000 solution (10 mcg/mL), administered at 30-100 mL/h 1
- More concentrated preparation: 4 mg in 250 mL yields 16 mcg/mL for patients requiring fluid restriction 1
- More dilute preparation: Use concentrations less than 4 mcg/mL when large fluid volumes are clinically needed 2
Stability Considerations
- Norepinephrine solutions at both 4 mcg/mL and 16 mcg/mL concentrations remain chemically stable for 7 days at room temperature under ambient light when diluted in either D5W or normal saline 3
- Solutions maintain >95% of original concentration after 168 hours of storage 3
Critical Administration Requirements
- Central venous access is strongly preferred to minimize extravasation risk and tissue necrosis 1, 2
- If extravasation occurs, immediately infiltrate 5-10 mg phentolamine diluted in 10-15 mL saline at the site 1, 2
- Never mix with sodium bicarbonate or alkaline solutions in the IV line, as norepinephrine is inactivated in alkaline environments 1, 2
- Discard solution if color is pinkish or darker than slightly yellow, or if precipitate is present 2