Norepinephrine Velpharm  

Dosage regimen

Enter only intravenously.
The individual dose of the drug is determined by the doctor depending on the clinical condition of the patient.
Norepinephrine must be administered via central venous access devices to reduce the risk of extravasation and subsequent tissue necrosis.
Before or during therapy, correction of hypovolemia, hypoxia, acidosis, hypercapnia is necessary.

The initial dose and rate of administration of the drug is recommended - from 0,1 to 0,3 mcg/kg/min norepinephrine bitartrate. The infusion rate is progressively increased by titration step by step, at 0,05 - 0,1 mcg/kg/min, in accordance with the observed pressor effect until the desired normotonia is achieved.
There are individual differences in the dose required to achieve and maintain normotonia. The goal is to achieve the lower lim it of systolic blood pressure (100 - 120 mm Hg) or to achieve a sufficient average level (above 65 - 80 mm Hg, depending on the patient's condition). The individual dose, due to the high variability of the clinical response when administering the drug, is set depending on the condition of the patient.
Norepinephrine should be used simultaneously with proper replenishment of the circulating blood volume.
It is necessary to beware of introducing a norepinephrine solution under the skin and muscles because of the danger of developing necrosis.

The concentrate should be diluted in a 5% glucose solution (dextrose). Do not enter not diluted! Do not mix with other drugs!
For administration using a syringe infusion pump: 48 ml of a 5% glucose solution (dextrose) is added to 2 ml of concentrate for the preparation of a solution for intravenous administration.
For administration by dropper: add to the 20 ml of concentrate to prepare a solution for intravenous administration of a drug 480 ml of 5% glucose solution (dextrose).
In both dilutions, the final concentration of the obtained solution for intravenous administration is 0,08 mg/ml norepinephrine bitartrate, which corresponds to 0,04 mg/ml norepinephrine base.
Volume of fluid injected: the dilution level depends on the patient's condition. If the introduction of a large volume of fluid is required, the drug should be diluted with a large amount of glucose (dextrose) and, therefore, a lower concentration drug should be used for administration. If it is undesirable to inject a large volume of liquid, the concentrate is diluted with a smaller volume of glucose (dextrose), obtaining a more concentrated solution.

The duration, rate of administration and dosing of norepinephrine solution is determined by cardiac activity data with mandatory medical monitoring of blood pressure (BP) (every 2 minutes until normotonia is reached, after - every 5 minutes during the entire infusion) to avoid the occurrence of arterial hypertension.
The simultaneous administration of MAO inhibitors of the imipramine and tryptylin series increases the risk of developing a pronounced and prolonged increase in blood pressure.

Therapy should be reduced in stages, since abrupt cancellation can lead to acute arterial hypotension.
The course of treatment can last from several hours to 6 days.
Features of the action of the drug at the first dose or during cancellation At the beginning of the infusion, it is necessary to titrate the dose of the drug to achieve the target blood pressure. With prolonged use, a decrease in plasma volume with the necessary correction is possible to avoid recurrent hypotension when the drug is canceled.

Contraindications