noradrenaline tartrate: clinical use

Prescribing considerations

• Select the presentation appropriate to the clinical setting and intended venous access.
• Assess and correct inadequate circulating volume; vasopressor treatment does not replace appropriate fluid or blood-volume management.
• Administration requires experienced staff and facilities for close cardiovascular monitoring.
• Avoid abrupt withdrawal because acute hypotension may occur.
• The selected products are licensed for adults; paediatric safety and efficacy have not been established.

Contraindications and cautions

• Hypersensitivity to noradrenaline or a listed excipient.
• Concomitant cyclopropane or halothane anaesthesia.
• Peripheral administration is contraindicated for the selected emergency infusion presentation but is permitted for Vipranop.
• Hypotensive collapse caused by hypovolaemia, except as a temporary emergency measure to preserve coronary and cerebral perfusion while volume replacement is instituted.

Monitoring

• Frequent or continuous blood-pressure assessment, with arterial monitoring where appropriate.
• Heart rate, rhythm and overall haemodynamic response.
• Infusion-site patency and signs of blanching or extravasation.
• Peripheral and visceral perfusion, including limb appearance and urine output.
• Fluid and electrolyte status during prolonged vasopressor treatment.

Clinical pharmacology

Noradrenaline is an endogenous catecholamine with predominantly alpha-adrenergic vascular activity and beta-1 cardiac activity. It increases systemic vascular resistance and blood pressure, while vasoconstriction can reduce renal, hepatic, cutaneous and peripheral blood flow. Its effect declines rapidly after an infusion is stopped.

Formulation and product differences

• The emergency infusion presentation is ready to use, intended for hypotensive emergencies and requires central venous administration.
• Vipranop is a ready-to-use peri-operative presentation that may be given by peripheral or central venous injection or infusion; its concentration is not adapted to critical-care use.
• Both selected products are single-use solutions, contain sodium and should not be mixed with other medicines.

Solution for infusion

Route: Intravenous

Strengths: 0.08 mg/mL, 0.16 mg/mL, 1 mg/mL

Injection

Route: Parenteral

Strengths: 5 micrograms/mL