DOSAGE AND ADMINISTRATION
Norepinephrine Bitartrate Injection is a concentrated,
potent drug which must be diluted in dextrose containing solutions prior to infusion.
An infusion of LEVOPHED should be given into a large vein (see PRECAUTIONS).
Restoration Of Blood Pressure In Acute Hypotensive States
Blood volume depletion should always be corrected as
fully as possible before any vasopressor is administered. When, as an emergency
measure, intraaortic pressures must be maintained to prevent cerebral or
coronary artery ischemia, LEVOPHED can be administered before and concurrently
with blood volume replacement.
LEVOPHED should be diluted in 5 percent dextrose
injection or 5 percent dextrose and sodium chloride injections. These dextrose
containing fluids are protection against significant loss of potency due to
oxidation. Administration in saline solution alone is not recommended. Whole
blood or plasma, if indicated to increase blood volume, should be administered
separately (for example, by use of a Y-tube and individual containers if given
Add a 4 mL ampul (4 mg) 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).
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 ampuls) may be necessary if the patient remains hypotensive, but occult
blood volume depletion should always be suspected and corrected when present.
Central venous pressure monitoring is usually helpful in detecting and treating
The degree of dilution depends on clinical fluid volume
requirements. If large volumes of fluid (dextrose) are needed at a flow rate
that would involve an excessive dose of the pressor agent per unit of time, a
solution more dilute than 4 mcg per mL should be used. On the other hand, when
large volumes of fluid are clinically undesirable, a concentration greater than
4 mcg per mL may be necessary.
Duration Of Therapy
The infusion should be continued until adequate blood
pressure and tissue perfusion are maintained without therapy. Infusions of
LEVOPHED should be reduced gradually, avoiding abrupt withdrawal. In some of
the reported cases of vascular collapse due to acute myocardial infarction,
treatment was required for up to six days.
Adjunctive Treatment In Cardiac Arrest
Infusions of LEVOPHED are usually administered
intravenously during cardiac resuscitation to restore and maintain an adequate
blood pressure after an effective heartbeat and ventilation have been established
by other means. [LEVOPHED's powerful beta-adrenergic stimulating action is also
thought to increase the strength and effectiveness of systolic contractions
once they occur.]
To maintain systemic blood pressure during the management
of cardiac arrest, LEVOPHED is used in the same manner as described under
Restoration of Blood Pressure in Acute Â Hypotensive States.
Parenteral drug products should be inspected visually for
particulate matter and discoloration prior to use, whenever solution and
Do not use the solution if its color is pinkish or darker
than slightly yellow or if it contains a precipitate.
Avoid contact with iron salts, alkalis, or oxidizing
LEVOPHED, norepinephrine bitartrate injection, USP,
contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL).
Ampuls of 4 mL in boxes of 10, NDC 0409-1443-04
Store at 20 to 25°C (68 to 77°F). [See USP Controlled
Protect from light.
Hospira, Inc., Lake Forest, IL 60045 USA. Revised: