Levofed
Generic Name
Norepinephrine Bitartrate
Manufacturer
Hospira (a Pfizer Company)
Country
USA
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| levofed 2 mg injection | ৳ 250.00 | N/A |
Description
Overview of the medicine
Levofed (Norepinephrine) is a potent vasopressor and inotropic agent primarily used to treat severe hypotension and shock, such as septic shock, cardiogenic shock, and other acute hypotensive states.
Uses & Indications
Dosage
Adults
Initial dose: 0.01-3 mcg/kg/min intravenous infusion, titrated to achieve desired blood pressure. Maintenance dose: Typically 0.05-0.3 mcg/kg/min.
Elderly
Similar to adults, but cautious titration is recommended due to potential for increased sensitivity and comorbidities.
Renal_impairment
No specific dosage adjustment guidelines; use with caution and monitor hemodynamic parameters closely.
How to Take
Administered as a continuous intravenous infusion, preferably via a central venous catheter. Must be diluted in 5% Dextrose Injection or 5% Dextrose in Sodium Chloride Injection. Avoid abrupt withdrawal.
Mechanism of Action
Norepinephrine acts on alpha-1 adrenergic receptors to cause vasoconstriction, leading to increased systemic vascular resistance and blood pressure. It also acts on beta-1 adrenergic receptors in the heart to increase myocardial contractility and heart rate.
Pharmacokinetics
Onset
Rapid onset of action, typically within 1-2 minutes.
Excretion
Metabolites are primarily excreted in the urine.
Half life
Short plasma half-life of approximately 2.4 minutes.
Absorption
Administered intravenously, resulting in 100% bioavailability.
Metabolism
Rapidly metabolized by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) in the liver and other tissues.
Side Effects
Contraindications
- Hypovolemic shock (unless fluid resuscitation is adequately completed)
- Mesenteric or peripheral vascular thrombosis (due to increased risk of ischemia and infarction)
- Anesthesia with cyclopropane or halothane (due to increased risk of ventricular fibrillation)
Drug Interactions
Oxytocin
Increased pressor effects.
Cardiac Glycosides
Increased risk of arrhythmias.
Alpha and Beta Blockers
Antagonistic effects, potentially reducing effectiveness of norepinephrine or causing reflex bradycardia.
Tricyclic Antidepressants (TCAs)
Potentiation of pressor effects.
Monoamine Oxidase Inhibitors (MAOIs)
Potentiation of pressor effects, leading to severe hypertension.
Antihistamines (e.g., diphenhydramine)
May potentiate pressor effects.
Storage
Store at controlled room temperature (20°C to 25°C), protect from light. Do not freeze.
Overdose
Symptoms of overdose include severe hypertension, headache, reflex bradycardia, and arrhythmias. Management involves discontinuing the infusion and providing symptomatic and supportive care. Phentolamine may be used to counteract severe pressor effects.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. It is unknown if norepinephrine is excreted in human milk; use with caution during lactation.
Side Effects
Contraindications
- Hypovolemic shock (unless fluid resuscitation is adequately completed)
- Mesenteric or peripheral vascular thrombosis (due to increased risk of ischemia and infarction)
- Anesthesia with cyclopropane or halothane (due to increased risk of ventricular fibrillation)
Drug Interactions
Oxytocin
Increased pressor effects.
Cardiac Glycosides
Increased risk of arrhythmias.
Alpha and Beta Blockers
Antagonistic effects, potentially reducing effectiveness of norepinephrine or causing reflex bradycardia.
Tricyclic Antidepressants (TCAs)
Potentiation of pressor effects.
Monoamine Oxidase Inhibitors (MAOIs)
Potentiation of pressor effects, leading to severe hypertension.
Antihistamines (e.g., diphenhydramine)
May potentiate pressor effects.
Storage
Store at controlled room temperature (20°C to 25°C), protect from light. Do not freeze.
Overdose
Symptoms of overdose include severe hypertension, headache, reflex bradycardia, and arrhythmias. Management involves discontinuing the infusion and providing symptomatic and supportive care. Phentolamine may be used to counteract severe pressor effects.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. It is unknown if norepinephrine is excreted in human milk; use with caution during lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years, as indicated on the packaging.
Availability
Hospitals, Critical Care Units
Approval Status
Approved (e.g., FDA, DGDA)
Patent Status
Generic
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials and observational studies have established norepinephrine as a first-line vasopressor for various forms of shock, particularly septic shock.
Lab Monitoring
- Continuous blood pressure monitoring
- Heart rate
- Cardiac output (if available)
- Urine output
- Peripheral perfusion (e.g., capillary refill)
- Blood gases
- Lactate levels
Doctor Notes
- Always ensure adequate fluid resuscitation prior to or concurrent with norepinephrine initiation.
- Monitor for signs of extravasation closely and treat promptly with phentolamine if it occurs.
- Titrate norepinephrine infusion rate carefully to maintain target mean arterial pressure, avoiding excessive hypertension.
Patient Guidelines
- Patients receiving norepinephrine are typically in critical condition and require continuous medical supervision. Caregivers should report any signs of discomfort, pain at the infusion site, or changes in the patient's condition immediately.
- Ensure adequate fluid resuscitation before starting norepinephrine.
- Continuous monitoring of vital signs is crucial.
Missed Dose Advice
Norepinephrine is administered in acute critical care settings under continuous monitoring, so missed doses are not applicable.
Driving Precautions
Not applicable as patients receiving this medication are in critical condition and unable to drive or operate machinery.
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