What are the dosages for a Norepinephrine (Levophed) drip?

From the Guidelines

Levophed (norepinephrine) should be dosed at 0.2–1.0 μg/kg/min IV, as recommended by the most recent guidelines 1. The dosing of Levophed (norepinephrine) is crucial in managing acute heart failure, and the recommended infusion rate is 0.2–1.0 μg/kg/min IV.

• The standard preparation is typically 4 mg norepinephrine in 250 mL D5W or NS, yielding a concentration of 16 mcg/mL.
• Start at 0.2 μg/kg/min and increase by 0.05-0.1 μg/kg/min every 5 minutes until target mean arterial pressure (MAP) of 65-70 mmHg is achieved.
• Most patients respond to doses between 0.2-0.5 μg/kg/min, though doses up to 1.0 μg/kg/min may be used in severe shock.
• Levophed must be administered via a central line due to risk of extravasation and tissue necrosis.
• Continuous blood pressure monitoring is essential during administration, preferably with an arterial line.
• Levophed works by stimulating alpha-1 adrenergic receptors, causing vasoconstriction to increase blood pressure, and has some beta-1 activity to support cardiac output.
• Once hemodynamic stability is achieved, gradually wean the infusion by decreasing the rate by 0.05-0.1 μg/kg/min every 15-30 minutes while monitoring for hypotension, as recommended by the guidelines 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Norepinephrine Bitartrate Injection is a concentrated, potent drug which must be diluted in dextrose containing solutions prior to infusion. 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 Give this solution by intravenous infusion. After observing the response to an initial dose of 2 mL to 3 mL (from 8 mcg to 12 mcg of base) per minute, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 mm Hg to 100 mm Hg systolic) sufficient to maintain the circulation to vital organs The average maintenance dose ranges from 0. 5 mL to 1 mL per minute (from 2 mcg to 4 mcg of base).

The dosages for a Levophed drip are as follows:

• Initial dose: 2 mL to 3 mL (from 8 mcg to 12 mcg of base) per minute
• Average maintenance dose: 0.5 mL to 1 mL per minute (from 2 mcg to 4 mcg of base)
• Dilution: 4 mg/4 mL of LEVOPHED in 1,000 mL of a 5 percent dextrose containing solution, with each mL containing 4 mcg of the base of LEVOPHED 2

From the Research

Dosages for Levophed Drip

The provided studies do not directly mention the dosages for a Levophed drip. However, they do discuss the use of norepinephrine, which is another name for Levophed, in various clinical settings.

• The study 3 mentions that norepinephrine was administered at doses of 0.05,0.1, and 0.2 µg/kg/min in newborn piglets with hypoxia-reoxygenation.
• The study 4 mentions that norepinephrine was administered in incremental doses, but the specific doses are not provided.

Clinical Applications

The studies discuss the clinical applications of vasoactive medications, including norepinephrine, in the treatment of shock and hypotension.

• The study 5 summarizes the pharmacologic properties of vasoactive medications, including norepinephrine, and discusses their clinical application in the intensive care unit.
• The study 6 describes the pharmacology and clinical applications of inotropic and vasopressor agents, including norepinephrine, in critically ill patients.
• The study 7 evaluates the temporal trends and clinical outcomes associated with vasopressor and inotrope use in the cardiac intensive care unit, and finds that norepinephrine is associated with lower mortality in some patients with shock.

Hemodynamic Effects

The studies discuss the hemodynamic effects of norepinephrine and other vasoactive medications.

• The study 3 finds that norepinephrine improves cardiac contractile function, cardiac output, blood pressure, and cerebral perfusion in a dose-related manner in newborn piglets with hypoxia-reoxygenation.
• The study 4 finds that norepinephrine and dobutamine improve cardiac index equally, but through different mechanisms, in an experimental model of chronic pulmonary hypertension.