Noradrenaline (Norepinephrine) Laboratoire Aguettant (Noradrenaline Tartrate)

Noradrenaline (norepinephrine) acts on the sympathetic cardiovascular pathway to restore vascular tone and cardiac output in critical care settings.

• Hypotension: increases systemic vascular resistance to raise arterial pressure.
• Septic shock: restores hemodynamic stability by vasoconstriction and improving cardiac output.
• Cardiac arrest: supports circulation during resuscitation by enhancing coronary perfusion 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, raising systemic vascular resistance. Concurrent beta‑1 activation increases heart rate and myocardial contractility, augmenting cardiac output. The combined effect rapidly elevates arterial pressure and improves organ perfusion in acute hypotensive states.

Norepinephrine may cause a range of adverse reactions that vary with dose, infusion rate, and patient condition.

Common Side Effects

• Tachycardia: rapid heart rate due to beta‑1 stimulation.
• Hypertension: excessive rise in blood pressure from strong vasoconstriction.
• Headache: secondary to elevated arterial pressure.
• Anxiety or restlessness: central nervous system stimulation.
• Peripheral ischemia: reduced blood flow to extremities.
• Arrhythmia: irregular heart rhythm, especially in susceptible patients.

Serious or Rare Side Effects

• Myocardial ischemia: reduced coronary blood flow leading to chest pain or infarction.
• Severe hypertension: dangerously high blood pressure that may cause vascular injury.
• Tissue necrosis at infusion site: extravasation can result in local tissue damage.
• Pulmonary edema: fluid accumulation in lungs due to increased afterload.
• Cardiac arrest: paradoxical severe cardiac dysfunction.
• Life‑threatening arrhythmic cardiac arrest.

When using norepinephrine, careful monitoring and specific safety measures are essential.

• Monitor blood pressure: adjust infusion to avoid excessive hypertension.
• Assess cardiac function: watch for tachyarrhythmias and myocardial ischemia.
• Use with caution in coronary artery disease: increased risk of ischemic events.
• Avoid extravasation: ensure secure intravenous access to prevent local tissue necrosis.
• Limit use in severe peripheral vascular disease: risk of limb ischemia.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Norepinephrine interacts with several drug classes that can modify its hemodynamic effects.

Major Interactions (Avoid)

• Monoamine oxidase inhibitors (MAOIs): may precipitate hypertensive crisis.
• Tricyclic antidepressants: additive sympathomimetic activity can cause severe hypertension.
• Beta‑blockers: may blunt desired cardiac response.
• Epinephrine or other catecholamines: risk of excessive vasoconstriction.
• Calcium channel blockers: unpredictable blood pressure changes.

Moderate Interactions (Monitor Closely)

• Vasodilators (e.g., nitroglycerin): may reduce norepinephrine efficacy.
• ACE inhibitors or ARBs: can potentiate hypotensive episodes.
• Diuretics: may alter intravascular volume affecting response.
• Anesthetic agents (e.g., propofol): may require dose adjustments.
• Clonidine: abrupt withdrawal can lead to rebound hypertension.