Noradrenaline (Norepinephrine) Pfizer Healthcare Ireland (Noradrenaline Tartrate)

Noradrenaline (norepinephrine) is a vasopressor used in critical care to support circulatory function.

• Hypotension: increases systemic vascular resistance to raise arterial pressure.
• Septic shock: restores perfusion pressure when fluids alone are insufficient.
• Cardiogenic shock: improves cardiac output by enhancing contractility and vascular tone.
• Cardiac arrest: provides immediate pressor support during resuscitation efforts.

• Norepinephrine acts as a direct agonist at alpha‑1 adrenergic receptors, causing peripheral vasoconstriction, and at beta‑1 receptors, increasing myocardial contractility and heart rate. The combined alpha‑1 mediated increase in systemic vascular resistance and beta‑1 mediated rise in cardiac output elevates mean arterial pressure, supporting organ perfusion in shock states.

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

Common Side Effects

• Headache: mild to moderate intensity.
• Tachycardia: increased heart rate.
• Arrhythmia: irregular cardiac rhythm.
• Nausea: occasional gastrointestinal upset.

Serious or Rare Side Effects

• Severe hypertension: dangerously high blood pressure.
• Myocardial ischemia: reduced heart muscle blood supply.
• Tissue necrosis at infusion site: local tissue death.

When using norepinephrine, careful monitoring and specific precautions are required.

• Monitor blood pressure continuously: adjust infusion to maintain target MAP.
• Assess cardiac rhythm: watch for tachyarrhythmias or bradycardia.
• Use central venous access when possible: reduce risk of extravasation.
• Avoid concurrent use with MAO inhibitors: may potentiate pressor effects.
• Adjust dose in patients with coronary artery disease: risk of ischemia.
• 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 require close monitoring.

Major Interactions (Avoid)

• MAO inhibitors: synergistic increase in catecholamine effects.
• Tricyclic antidepressants: additive pressor response.
• Beta‑blockers: may blunt desired beta‑1 effects.

Moderate Interactions (Monitor Closely)

• Vasodilators (e.g., nitroglycerin): may require higher norepinephrine dose.
• Calcium channel blockers: potential for enhanced hypotension if norepinephrine withdrawn.
• Diuretics: may affect intravascular volume and response.