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Vasopressor / Inotrope

Norepinephrine

Potent α + modest β1 agonist · Levophed

Mechanism: α1 vasoconstriction with mild β1 inotropy.

Onset
<1 min
Duration
1–2 min
Metabolism
MAO/COMT.

Dosing

Adult
Infusion 0.02–1 mcg/kg/min (titrate).
Pediatric
0.05–0.5 mcg/kg/min.

Indications

  • Septic shock (first-line)
  • Vasodilatory shock

Contraindications

  • Mesenteric/peripheral vascular thrombosis (relative)

Side Effects

  • Arrhythmia
  • Peripheral ischemia/extravasation injury (treat with phentolamine)

Clinical Pearls

1Now safely run via large-bore peripheral IV at low concentrations short-term (consensus shift).

References & Further Reading

  1. 1
    Textbook

    Flood P, Rathmell JP, Shafer S. Stoelting's Pharmacology and Physiology in Anesthetic Practice. 5th ed. Philadelphia: Wolters Kluwer; 2015.

  2. 2
    Guideline

    Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063-e1143.

  3. 3
    Textbook

    Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.

  4. 4
    Textbook

    Adriano A, Morris R, eds. 2021 CA-1 Tutorial Textbook (15th Ed.). Stanford University Medical Center, Department of Anesthesiology.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.