Noradrenaline Kabi (Noradrenaline Tartrate)

Noradrenaline Kabi is a vasopressor used in the management of acute circulatory failure and shock.

• Hypotension: raises systemic vascular resistance to achieve target mean arterial pressure in critically ill patients with refractory low blood pressure.
• Septic shock: counteracts vasodilatory failure by inducing vasoconstriction, supporting perfusion during severe infection‑related circulatory collapse.
• Cardiogenic shock: enhances cardiac output and arterial pressure when myocardial pump function is insufficient, aiding hemodynamic stabilization.

• Norepinephrine acts as a direct agonist at α1‑adrenergic receptors on vascular smooth muscle, causing potent vasoconstriction, and at β1‑adrenergic receptors in the heart, increasing contractility and heart rate. The combined α‑ and β‑stimulating effects raise systemic vascular resistance and cardiac output, rapidly improving arterial pressure in shock states. Its rapid onset and short half‑life allow titration via continuous intravenous infusion, and it is metabolized primarily by monoamine oxidase and catechol‑O‑methyltransferase.

Noradrenaline Kabi may be associated with a range of adverse reactions, varying from frequent to rare but serious.

Common Side Effects

• Headache: mild to moderate headache reported during infusion, often relieved by analgesics.
• Tachycardia: increased heart rate due to β1 stimulation, may require rate control.
• Peripheral ischemia: reduced blood flow to extremities causing coldness or pain.
• Nausea: occasional nausea or vomiting.
• Anxiety: feelings of restlessness or nervousness.
• Dizziness: transient light‑headedness during dose adjustments.

Serious or Rare Side Effects

• Cardiac arrhythmias: potentially life‑threatening rhythm disturbances.
• Severe hypertension: abrupt excessive rise in blood pressure.
• Tissue necrosis: extravasation at the infusion site leading to local tissue damage.

When using Noradrenaline Kabi, clinicians should observe several safety precautions to minimize risks.

• Dose titration: adjust infusion rate to achieve target blood pressure while monitoring hemodynamics.
• Cardiac monitoring: continuous ECG and heart‑rate surveillance is required due to β1 effects.
• Peripheral perfusion: assess limb circulation regularly to detect ischemia from vasoconstriction.
• Drug compatibility: avoid mixing with solutions containing calcium or bicarbonate that may precipitate.
• Pregnancy and lactation: use only if potential benefit justifies potential risk, as safety data are limited.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Noradrenaline Kabi can interact with other agents, altering its efficacy or safety profile.

Major Interactions (Avoid)

• MAO inhibitors: concurrent use may cause excessive hypertensive response.
• β‑blockers: may blunt β1‑mediated cardiac effects, reducing desired increase in output.

Moderate Interactions (Monitor Closely)

• Vasodilators (e.g., nitroglycerin): may counteract pressor effect, requiring dose adjustments.
• Diuretics: volume depletion can enhance hypotensive risk if norepinephrine is reduced.
• Calcium channel blockers: may potentiate vasoconstriction and increase risk of ischemia.