What is the dosing range of norepinephrine (norepi) for blood pressure (BP) support in hypotension?

From the Guidelines

Norepinephrine for blood pressure support is typically dosed between 0.01 to 3 mcg/kg/min as a continuous intravenous infusion, with most patients responding to doses between 0.05 to 0.5 mcg/kg/min, as recommended by the Surviving Sepsis Campaign guidelines 1. The dosing range of norepinephrine for blood pressure support is crucial in managing septic shock and other conditions requiring vasopressor support.

• The initial dose should be 0.01-0.03 mcg/kg/min, titrated every 3-5 minutes to achieve the target mean arterial pressure (MAP), usually 65 mmHg or higher depending on the clinical situation, as suggested by the guidelines 1.
• The maximum recommended dose is 3 mcg/kg/min, though doses above 1 mcg/kg/min rarely provide additional benefit and may increase adverse effects, such as decreased renal and splanchnic perfusion 1.
• Norepinephrine should be administered through a central venous catheter whenever possible to avoid extravasation risk, and continuous blood pressure monitoring is essential, as recommended by the guidelines 1.
• The medication works primarily as an alpha-1 adrenergic agonist causing peripheral vasoconstriction, with some beta-1 activity increasing cardiac contractility.
• When discontinuing, taper gradually to avoid rebound hypotension.
• Be aware that prolonged use at high doses may cause decreased renal and splanchnic perfusion, and concurrent volume resuscitation is often necessary in hypovolemic patients, as noted in the guidelines 1. Key considerations in dosing norepinephrine include:
• Targeting a mean arterial pressure (MAP) of 65 mmHg, as recommended by the Surviving Sepsis Campaign guidelines 1.
• Individualizing the target MAP based on the patient's condition and response to therapy.
• Monitoring for adverse effects, such as arrhythmias and decreased renal and splanchnic perfusion.
• Adjusting the dose accordingly to balance the benefits and risks of norepinephrine therapy, as suggested by the guidelines 1.

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 Give this solution by intravenous infusion. Insert a plastic intravenous catheter through a suitable bore needle well advanced centrally into the vein and securely fixed with adhesive tape, avoiding, if possible, a catheter tie-in technique as this promotes stasis An IV drip chamber or other suitable metering device is essential to permit an accurate estimation of the rate of flow in drops per minute 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 In previously hypertensive patients, it is recommended that the blood pressure should be raised no higher than 40 mm Hg below the preexisting systolic pressure. The average maintenance dose ranges from 0. 5 mL to 1 mL per minute (from 2 mcg to 4 mcg of base). 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 dosing range of norepinephrine for blood pressure support is:

• Initial dose: 8 mcg to 12 mcg of base per minute
• Average maintenance dose: 2 mcg to 4 mcg of base per minute
• High dosage: up to 68 mg base or 17 vials per day, titrated according to patient response 2

From the Research

Dosing Range of Norepinephrine for Blood Pressure Support

• The dosing range of norepinephrine for blood pressure support is not explicitly stated in the provided studies, but the studies suggest that the optimal dosing strategy is still unclear 3, 4.
• A study published in 2025 suggests that noradrenaline (norepinephrine) can be initiated at 0.05 mcg/kg/min with a maximum of 0.15 mcg/kg/min for up to 24 hours to support blood pressure in patients with hypotension 5.
• Another study published in 2019 suggests that the combination of central venous pressure (CVP) and mean arterial pressure (MAP) can help guide the adjustment of norepinephrine dosage in patients with septic shock 4.
• The optimal blood pressure target for norepinephrine therapy is also not explicitly stated, but a study published in 2017 suggests that targeting a mean arterial pressure of at least 65 mmHg is recommended, with higher values in case of chronic hypertension 3.
• A study published in 2020 compared the effects of vasopressin and norepinephrine on renal perfusion, oxygenation, and function in experimental septic acute kidney injury, and found that vasopressin induced a more sustained improvement in renal function than norepinephrine 6.
• A study published in 2019 compared the effects of norepinephrine and vasopressin with norepinephrine and epinephrine in adults with septic shock, and found that shock-free survival durations were similar between the two groups 7.