Noradrenaline (Norepinephrine) Wockhardt Uk (Noradrenaline Tartrate)

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

• Hypotension: increases systemic vascular resistance to raise arterial pressure in patients with low blood pressure.
• Shock: improves perfusion pressure and organ blood flow in septic, cardiogenic or hypovolemic shock states.
• Cardiac arrest: supports coronary and cerebral circulation during resuscitation efforts.

• Norepinephrine acts as a direct agonist at α1‑adrenergic receptors, causing peripheral vasoconstriction, and at β1‑adrenergic receptors, enhancing myocardial contractility and heart rate. The combined α1‑mediated increase in systemic vascular resistance and β1‑mediated rise in cardiac output elevates mean arterial pressure, making it an effective vasopressor in acute hypotensive emergencies. It also modestly stimulates β2 receptors, contributing to limited bronchodilation, but the primary clinical effect is pressor activity.

Norepinephrine may produce a range of adverse reactions, which are classified by frequency and severity.

Common Side Effects

• Tachycardia: rapid heart rate due to β1 stimulation.
• Hypertension: excessive rise in blood pressure from α1 vasoconstriction.
• Arrhythmia: irregular cardiac rhythm, especially in susceptible patients.
• Headache: vascular headache related to pressure changes.
• Anxiety or restlessness: central nervous system stimulation.
• Peripheral ischemia: reduced blood flow to extremities causing coldness or pain.

Serious or Rare Side Effects

• Myocardial ischemia: chest pain or infarction from increased cardiac workload.
• Severe hypertension: dangerous elevation of blood pressure requiring immediate intervention.
• Tissue necrosis at infusion site: extravasation leading to local tissue damage.
• Pulmonary edema: fluid accumulation in lungs due to cardiac overload.
• Cardiac arrest: paradoxical cessation of heart activity in rare cases.

When using norepinephrine, clinicians should observe specific safety measures to minimize complications.

• Monitor blood pressure: adjust infusion rate to avoid excessive hypertension.
• Cardiac monitoring: continuous ECG to detect arrhythmias.
• Use cautiously in coronary artery disease: risk of myocardial ischemia.
• Avoid rapid bolus administration: give as controlled infusion.
• Adjust dose in hypovolemia: ensure adequate fluid resuscitation before vasopressor.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Norepinephrine can interact with other medicines, altering its pressor effect or safety profile.

Major Interactions (Avoid)

• MAO inhibitors: may precipitate hypertensive crisis.
• Tricyclic antidepressants: additive pressor response increasing blood pressure.
• Beta‑blockers: can blunt expected tachycardia and mask hypotension.

Moderate Interactions (Monitor Closely)

• Calcium channel blockers: may enhance hypotensive effect.
• ACE inhibitors: can augment blood pressure variability.