Noradrenaline (Norepinephrine) Kabi (Noradrenaline Tartrate)

Noradrenaline acts on the adrenergic system to restore vascular tone and cardiac output in critical care settings.

• Hypotension: increases systemic vascular resistance to maintain adequate blood pressure.
• Septic shock: restores perfusion pressure in distributive shock.
• Cardiac arrest: supports coronary and cerebral perfusion during resuscitation.

• Norepinephrine binds directly to α1‑adrenergic receptors on vascular smooth muscle, causing potent vasoconstriction, and to β1‑adrenergic receptors on cardiac myocytes, enhancing heart rate and contractility. The combined α1‑mediated increase in systemic vascular resistance and β1‑mediated rise in cardiac output elevate mean arterial pressure, counteracting life‑threatening hypotension. These actions are dose‑dependent and are rapidly reversible upon discontinuation, allowing precise titration in intensive care environments.

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

Common Side Effects

• Tachycardia: increased heart rate due to β1 stimulation.
• Hypertension: excessive rise in blood pressure from α1 vasoconstriction.
• Arrhythmias: irregular heart rhythms, especially in susceptible patients.
• Peripheral ischemia: reduced blood flow to extremities causing coldness or pain.

Serious or Rare Side Effects

• Myocardial ischemia: reduced coronary perfusion leading to chest pain or infarction.
• Tissue necrosis: severe extravasation causing local tissue death.
• Severe hypertension crisis: dangerously high blood pressure requiring immediate intervention.

When using norepinephrine, clinicians should observe several precautionary measures to ensure safety and efficacy.

• Monitor blood pressure: adjust infusion to maintain target MAP.
• Assess cardiac function: watch for tachyarrhythmias and ischemia.
• Use central venous access: avoid extravasation and local tissue injury.
• Caution in peripheral vascular disease: risk of compromised limb perfusion.
• Review concomitant medications: especially MAO inhibitors and other pressor agents.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Norepinephrine can interact with other agents, influencing its pressor effect or safety profile.

Major Interactions (Avoid)

• MAO inhibitors: may precipitate hypertensive crisis.
• Tricyclic antidepressants: additive pressor effect increasing risk of severe hypertension.
• Beta‑blockers: may blunt desired cardiovascular response.

Moderate Interactions (Monitor Closely)

• Vasodilators (e.g., nitroglycerin, nitroprusside): may require higher norepinephrine doses.
• Calcium channel blockers: can enhance cardiovascular effects.
• General anesthetics: may alter hemodynamic stability during surgery.