Is Levophed the Same as Norepinephrine?
Yes, Levophed is simply the brand name for norepinephrine—they are the exact same medication. 1
Understanding the Terminology
- Levophed is the FDA-approved brand name manufactured as norepinephrine bitartrate for intravenous administration 1
- Norepinephrine is the generic name for this potent vasopressor medication 1
- Both terms refer to identical pharmacological agents with the same mechanism of action, dosing, and clinical applications 2, 1
Clinical Context for Severe Hypotension
When treating severe hypotension, whether you order "Levophed" or "norepinephrine," you receive the same drug with identical properties:
First-Line Vasopressor Status
- Norepinephrine (Levophed) is the recommended first-line vasopressor for septic shock and most forms of vasodilatory shock 2, 3, 4
- It is preferred over dopamine, epinephrine, and phenylephrine based on superior safety profiles and outcomes 2, 4
Standard Dosing Parameters
- Initial infusion typically starts at 0.5 mg/h (approximately 8-12 mcg/min or 0.1-0.5 mcg/kg/min) 3, 1
- Standard concentration: 4 mg norepinephrine in 250 mL D5W yields 16 mcg/mL 3, 1
- Target mean arterial pressure (MAP) of 65 mmHg for most patients with shock 3, 4, 5
Critical Administration Requirements
- Central venous access is strongly preferred to minimize tissue necrosis risk from extravasation 3, 4, 1
- If extravasation occurs, immediately infiltrate 5-10 mg phentolamine diluted in 10-15 mL saline at the site 3, 4
- Never administer to hypovolemic patients without concurrent fluid resuscitation—this is a critical contraindication that can cause severe organ hypoperfusion despite "normal" blood pressure 1
Essential Pre-Administration Step
- Administer minimum 30 mL/kg crystalloid bolus before or concurrent with norepinephrine initiation 3, 5
- In severe hypotension (systolic <70 mmHg), norepinephrine may be started emergently while fluid resuscitation continues 3
Common Pitfall to Avoid
The most dangerous error is using norepinephrine/Levophed to maintain blood pressure in hypovolemic patients without adequate volume replacement—this creates severe peripheral vasoconstriction, decreased organ perfusion, tissue hypoxia, and lactate acidosis despite seemingly "normal" blood pressure readings 1.