Norepinephrine

What norepinephrine is and how it works

Norepinephrine is a catecholamine vasopressor used to raise blood pressure in severe acute hypotension. It constricts blood vessels (alpha-adrenergic effect) and increases heart contractility (beta-adrenergic effect). It is administered only in hospital critical-care settings. (1) (2) (3) (4)

Norepinephrine is given exclusively by healthcare professionals in an intensive care unit, emergency department, or operating theatre. It is not a medicine you can take yourself, and it is not available for home use or through a pharmacy.

Mechanism of action: how norepinephrine works

Norepinephrine is a direct-acting sympathomimetic amine with predominant alpha-adrenergic activity (vasoconstriction) and some beta-1-adrenergic activity (positive inotropy). It raises systemic vascular resistance and blood pressure, with variable effects on heart rate and cardiac output. (1) (2) (3) (4)

What norepinephrine is used for

Before taking norepinephrine

Do not take / not appropriate for

• Do not use norepinephrine as sole therapy for hypotension due to hypovolaemia unless emergency volume replacement is also given. (all indications) (1) (2)
• Do not administer to patients with known hypersensitivity to norepinephrine or any excipient (e.g., sodium metabisulfite). (all products) (1) (2)
• Do not use with cyclopropane or halothane anaesthetics because of the risk of serious ventricular arrhythmias. (perioperative) (3) (4)

Tell your clinician about

• Clinicians must ensure the patient is not hypovolaemic; correct volume deficits first.
• Assess for peripheral vascular disease, mesenteric or peripheral thrombosis, coronary artery disease, hyperthyroidism, or diabetes.
• Check for concomitant monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, or linezolid, which can cause severe prolonged hypertension.
• Pregnancy: life-sustaining therapy should not be withheld; limited data do not suggest increased risk of major birth defects.
• Elderly patients: dose cautiously and avoid leg veins.

How to take norepinephrine

• Norepinephrine is given as a continuous intravenous infusion by a trained clinician in a hospital setting. It must be diluted before use (e.g., in 5% dextrose injection).
• The infusion is started at 8–12 mcg/min and then adjusted based on blood pressure response; typical maintenance is 2–4 mcg/min. Target systolic blood pressure is usually 80–100 mmHg.
• Blood pressure is monitored every 2 minutes initially, then every 5 minutes during the infusion.
• The infusion is given into a large vein (e.g., antecubital) or a central venous catheter to reduce the risk of extravasation. The infusion site is checked frequently.
• The infusion must be tapered gradually when discontinuing; sudden cessation can cause marked hypotension.

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5)

Missed dose

Not applicable. Norepinephrine is a continuous intravenous infusion under continuous monitoring. Any interruption must be managed by the clinical team immediately.

Overdose

Overdose may cause severe hypertension, reflex bradycardia, headache, and decreased cardiac output. The treating team may decide to slow or stop the infusion until the patient stabilises. Management is by the treating critical-care team. (1) (2)

Side effects

Adverse effects are typically related to excessive vasoconstriction or cardiac stimulation. The most serious risk is tissue ischaemia and necrosis from extravasation.

Serious warnings

Interactions

Pregnancy, breastfeeding, kidney/liver function, age

Monitoring

Before starting

• Confirm the need for vasopressor support and exclude/treat hypovolaemia.
• Ensure appropriate intravenous access (large vein or central line) and diluted solution.
• Check for known allergies (e.g., sulfite) and review concomitant medications (MAOIs, tricyclics).
• Establish baseline blood pressure, heart rate, and perfusion parameters.

During treatment

• Monitor blood pressure every 2 minutes until stable, then every 5 minutes.
• Inspect the infusion site regularly for signs of extravasation; if suspected, stop the infusion and administer phentolamine antidote.
• Assess for signs of tissue ischaemia (limb colour/temperature, urine output, lactate).
• Continuously monitor cardiac rhythm for arrhythmias.
• Adjust the infusion rate according to target blood pressure (usually systolic 80–100 mmHg) and patient response.

Storage

Storage conditions vary by manufacturer and product. Typically, vials are stored at controlled room temperature and protected from light. Refer to the specific product labeling. Diluted solutions have a limited stability and must be used within the recommended time.

Frequently asked questions

References

1. LEVOPHED (norepinephrine bitartrate) injection, solutionU.S. Food and Drug Administration (via DailyMed) · United States · accessed 2026-07-30 · source 1
2. Noradrenaline (Norepinephrine) 1 mg/ml concentrate for solution for infusion — Summary of Product Characteristicselectronic Medicines Compendium (UK) · United Kingdom · accessed 2026-07-30 · source 2
3. Norepinephrine Bitartrate Injection — Prescribing Information (J. Molner Company Inc., dated 2023-06-07)Health Canada · Canada · dated 2023-06-07 · accessed 2026-07-30 · source 3
4. LEVOPHED 1:1000 Concentrate for injection — Data SheetMedsafe, New Zealand Medicines and Medical Devices Safety Authority · New Zealand · accessed 2026-07-30 · source 4
5. ARTG Register — Norepinephrine/Levophed listingsTherapeutic Goods Administration · Australia · accessed 2026-07-30 · source 5
6. Centralised authorisation search — no norepinephrine entryEuropean Medicines Agency · European Union · accessed 2026-07-30 · source 6

Brand names by country

Single-ingredient norepinephrine names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries