Norepinephrine Injection (Norepinephrine Tartrate Hydrate)

Adult administration

As a norepinephrine tartrate hydrate, dilute 8mg (4mg as norepinephrine) in a 5% glucose injection or 5% glucose saline injection of 1000ml, and administer intravenously at a rate of 2-3ml per minute, adjusting according to response. The maintenance dose is 0.5-1.0ml per minute. In case of cardiac arrest, it is administered intravenously following establishment of effective cardiac rhythm and ventilation through other means similar to acute hypotension or shock.

This medication may have glass fragments upon cutting the injection container, so care should be taken during cutting to minimize the inclusion of glass fragments. Particularly, special attention is needed when used in children and the elderly. This medication should not be administered to specific patients. It should not be used until blood volume replacement therapy is completed for patients with hypotension due to blood volume deficiency, and it should also not be administered to patients with hypertension, hyperthyroidism, certain tumors, severe renal impairment, cor pulmonale, severe arrhythmias, cases of peripheral region anesthesia, pregnant women, or women who may become pregnant. Additionally, this medication should be administered cautiously to specific patients. It should be used with caution in cocaine addiction patients or patients with ventricular tachycardia, arteriosclerosis, heart disease, bradycardia, thrombosis, patients with myocardial infarction, certain angina patients, and the elderly only when necessary. This medication contains sodium bisulfite, which can cause allergic reactions or asthma attacks, thus great caution is necessary in asthma patients. Cardiovascular side effects such as palpitations, bradycardia, chest pain, abnormal blood pressure, arrhythmias, peripheral ischemia, and others may occur when using this medication. Also, side effects such as headache, dizziness, tremors, anxiety, and gastrointestinal symptoms like nausea and vomiting, breathing difficulties, necrosis at the injection site, and reduced plasma volume with prolonged use may occur. This medication acts as an emergency treatment that raises blood pressure and should not replace blood volume replacement therapy, while avoiding excessive blood pressure elevation or pulmonary edema, arrhythmias, cardiac arrest, hence it should be administered carefully. During administration, frequent monitoring of blood pressure and infusion rate is essential. This medication can interact with other drugs, so attention is crucial regarding concomitant medications. Particularly, when used in combination with certain anesthetics, catecholamine drugs, antidepressants, antihistamines, thyroid medications, or hypoglycemic agents, the risk of increased blood pressure or cardiac-related side effects may rise. Pregnant women or those who may become pregnant should not be administered as it may pose risks to the fetus, and caution should be exercised during breastfeeding as well. Caution is necessary when administering to the elderly due to a higher risk of blood pressure increases. In cases of overdose, symptoms such as severe hypertension, decreased cardiac output, bradycardia, headache, and pulmonary edema may arise, necessitating immediate cessation of administration and appropriate treatment. This medication requires caution regarding blood pressure elevation during intravenous administration, and care should be taken to prevent the injection fluid from leaking out of the vessel. Necrosis can occur at the injection site, so frequent checks are essential, and immediate appropriate measures should be taken if problems arise. This medication should be used in conjunction with specific solutions, and avoiding use with certain medications is safer.

Serious side effects

Breathing difficulties, pallor, necrosis at the injection site, severe sweating, cerebral hemorrhage, pulmonary edema, increased blood pressure, decreased cardiac output, reflex bradycardia, retrosternal pain, severe swelling (limb necrosis, etc.), severe allergic reactions (sulphite anaphylaxis, asthma attacks), severe headaches

Mild side effects

• Palpitations
• bradycardia
• dizziness
• tremors
• anxiety
• nausea
• vomiting
• increased abnormal blood pressure
• arrhythmias
• headache

This medication is sensitive to light and should be stored in a closed container that prevents light exposure. Additionally, it is best to store the medication at room temperature between 1 to 30 degrees Celsius.

Appearance

Brown ampoule containing a colorless liquid

Package unit

For domestic use) 4 milliliters x 10 ampoules For export) 2 milliliters x 10 ampoules, 4 milliliters x 10 ampoules