Noradrenaline (Norepinephrine) Kalceks (Norepinephrine)

Noradrenaline (Norepinephrine) acts on the adrenergic system to restore vascular tone and support cardiac output in critical‑care settings.

• Hypotension: restores vascular tone and raises arterial pressure.
• Septic shock: counteracts vasodilatory failure to maintain organ perfusion.
• Cardiogenic shock: improves cardiac output and systemic blood pressure.

• Norepinephrine is a direct agonist of alpha‑1 and beta‑1 adrenergic receptors. Stimulation of alpha‑1 receptors on vascular smooth muscle produces potent vasoconstriction, increasing systemic vascular resistance. Activation of beta‑1 receptors in the heart enhances myocardial contractility and heart rate, thereby raising cardiac output and arterial pressure.

Norepinephrine may cause a range of adverse reactions, from mild to life‑threatening.

Common Side Effects

• Headache: mild to moderate intensity.
• Tachycardia: increased heart rate.
• Arrhythmia: premature beats or irregular rhythm.
• Nausea: occasional gastrointestinal upset.
• Anxiety or restlessness.
• Peripheral ischemia: reduced blood flow to extremities.

Serious or Rare Side Effects

• Severe hypertension: dangerously high blood pressure.
• Myocardial ischemia: reduced heart muscle oxygen supply.
• Tissue necrosis at infusion site: extravasation injury.
• Cardiac arrest: sudden loss of heart function.
• Pulmonary edema: fluid accumulation in lungs.

Use of norepinephrine requires careful monitoring and specific safety measures.

• Continuous blood‑pressure monitoring: adjust infusion rate to target values.
• Central venous access preferred: reduces risk of extravasation.
• Titrate slowly in patients with tachyarrhythmias: avoid excessive heart rate.
• Caution in myocardial ischemia: may worsen oxygen demand.
• Avoid in uncontrolled hypertension: risk of severe pressure spikes.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Norepinephrine interacts with several drug classes; some combinations should be avoided while others need close observation.

Major Interactions (Avoid)

• MAO inhibitors: risk of hypertensive crisis.
• Tricyclic antidepressants: additive sympathomimetic effect.
• Beta‑blockers: may blunt desired increase in cardiac output.
• High‑dose local anesthetics: increased arrhythmia risk.

Moderate Interactions (Monitor Closely)

• Vasodilators (e.g., nitroglycerin): may require higher norepinephrine doses.
• ACE inhibitors: can potentiate hypotensive episodes.
• Diuretics: may affect intravascular volume and response.
• Calcium‑channel blockers: may alter vascular tone response.