noradrenaline: clinical use

Prescribing considerations

• Correct or concurrently treat inadequate circulating volume; vasoconstriction can mask continuing hypovolaemia.
• Use only where experienced staff and appropriate cardiovascular monitoring are available.
• Use particular caution with coronary, mesenteric or peripheral vascular disease, recent myocardial infarction, major left-ventricular dysfunction, arrhythmias, diabetes, hyperthyroidism, hypoxia or hypercarbia.
• Reduce the infusion gradually when withdrawing support because abrupt cessation can precipitate hypotension.
• There is no established experience in hepatic or renal impairment, and safety and efficacy are not established in children for the selected product.

Contraindications and cautions

• Hypersensitivity to noradrenaline or an excipient
• Hypotension caused by deficient circulating blood volume, except as a temporary emergency measure while replacement is instituted
• Concomitant cyclopropane or halothane anaesthesia

Monitoring

• Frequent or continuous blood-pressure assessment
• ECG, heart rate and rhythm
• Clinical tissue perfusion, limb colour and temperature
• Urine output and renal perfusion
• Lactate and other indicators of inadequate tissue perfusion when clinically appropriate
• Infusion site for extravasation or tissue ischaemia
• Circulating volume and fluid/electrolyte replacement

Clinical pharmacology

Noradrenaline is a potent alpha-adrenergic agonist with more moderate beta-1 activity. It increases peripheral vascular resistance and myocardial contractility. Following intravenous administration it is rapidly cleared by cellular uptake and metabolism, with a plasma half-life of approximately one to two minutes.

Formulation and product differences

• The selected product is a concentrate that must be diluted before intravenous infusion; it is not a ready-to-use solution.
• The solution should be clear, colourless or yellowish and free from visible particles; brown or particulate solution should not be used.
• The product is for single use and should be protected from light.
• Labelling may express noradrenaline as base or tartrate, so preparation calculations must distinguish between them.

Solution for infusion

Route: Intravenous

Strengths: 1 mg/mL