norepinephrine
Brand: Levophed
ISMP High Alert Prototype Drug
Drug Class: vasopressor
Drug Family: vasopressor
Subclass: endogenous catecholamine
Organ Systems: cardiovascular
Mechanism of Action
Potent alpha-1 agonist causing peripheral vasoconstriction increasing SVR and MAP; moderate beta-1 chronotropy/inotropy; reflex bradycardia may offset HR increase.
alpha-1 adrenergic receptor (predominant)beta-1 adrenergic receptor
Indications
- septic shock (first-line vasopressor)
- distributive shock
- cardiogenic shock (adjunct)
Contraindications
- hypovolemia (relative — ensure adequate volume resuscitation first)
Adverse Effects
Common
- hypertension
- reflex bradycardia
- peripheral ischemia
Serious
- extravasation necrosis
- severe hypertension
- ischemia
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | IV |
| Metabolism | MAO/COMT |
| Excretion | renal |
| Half-life | 1-2 min |
| Onset | immediate |
| Peak | immediate |
| Duration | minutes |
| Protein Binding | <0% |
| Vd | IV only |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| MAOIs | severe hypertension | major |
| tricyclic antidepressants | enhanced pressor response | major |
Nursing Considerations
- First-line vasopressor for septic shock (SSC guidelines)
- Administer via central line
- Titrate to MAP ≥65 mmHg
- Monitor peripheral circulation for ischemia
- Phentolamine for extravasation
Clinical Pearls
- Surviving Sepsis Campaign: first-line vasopressor in septic shock
- SOAP II: fewer arrhythmias than dopamine in septic shock
Safety Profile
Pregnancy avoid
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.