Norepinephrine (Levophed) Nursing Consideration

Are you wondering what norepinephrine is and how it can help your body? Norepinephrine is a hormone and neural transmitter found in the body, and it plays a vital role in enabling our bodies to respond to stress. Norepinephrine is used to treat low blood pressure due to shock.

This post will discuss what this powerful medicine does, its uses within clinical practice, and its potential side effects. If you’re curious about how the power of norepinephrine can help with specific medical issues, keep reading for more information on this helpful substance.

Definition of Norepinephrine (Levophed)

Norepinephrine, which is also called noradrenaline, is a medicine that is prescribed for individuals who have significantly- low blood pressure. This medication is typically administered in cases where intravenous fluids have not yielded a considerable improvement in blood pressure. Interestingly, norepinephrine is the same molecule as the hormone and neurotransmitter norepinephrine.

This neurotransmitter is primarily produced in the adrenal glands and functions in the sympathetic nervous system, which activates the “fight or flight” response.

This medication is slowly injected into a vein, allowing it to correct low blood pressure quickly. With its incredible benefits, norepinephrine remains a trusted medical tool for patients needing treatment.

It increases heart rate, blood pressure, and glucose levels to prepare the body for stress and danger. Norepinephrine has also been implicated in various psychological disorders, including depression, anxiety, and post-traumatic stress disorder, making it an important target for pharmaceutical intervention.

Much research is underway to understand better the role of norepinephrine in physical and mental health and its potential as a therapeutic agent.

The drug norepinephrine’s brand name is Levophed, discovered by Ulf von Euler in 1947.

Routes Of Administration

Norepinephrine is typically administered intravenously. It is injected into a vein through an IV drip or catheter. It can also be injected directly into the muscle or under the skin (subcutaneous injection).

It is important to remember that this drug must be taken as prescribed by your doctor and should not be taken more than the recommended dosage.

How Does It Work

Norepinephrine acts on both α1 and α2 adrenergic receptors, resulting in a contraction of the blood vessels and an increase in peripheral vascular resistance. This increases blood pressure while at the same time reducing the amount of blood supply to the gastrointestinal tract and kidneys.

Moreover, it affects beta-1 adrenergic receptors, leading to an elevation of heart rate and cardiac output. However, this rise is only short-lived because baroreceptor response to the increased blood pressure and enhanced vagal tone triggers a sustained decrease in heart rate. Generally speaking, norepinephrine has more of an effect on alpha receptors than beta receptors.

What is the Most Essential Information about Norepinephrine (Levophed)?

If possible, before you receive norepinephrine, tell your caregivers if you have:

  • high blood pressure (hypertension)
  • diabetes
  • coronary artery disease
  • circulation problems
  • varicose veins
  • overactive thyroid

Side Effects of Norepinephrine (Levophed)

Despite its many potential benefits, some possible side effects must be considered when using norepinephrine. These include:

  • pain, burning, discoloration, irritation, or skin changes where the injection was taken
  • weakness, sudden numbness, or feeling cold anywhere in your body
  • little or no urination
  • trouble breathing
  • blue lips or fingernails, mottled skin
  • problems with vision, speaking
  • severe headache, blurred vision, and pounding in your neck or ears.
  • Slow or uneven heart rate

This is a partial list of side effects, and others may occur. Immediately Call your doctor for medical advice about these side effects. You may also report side effects to FDA at 1-800-FDA-1088.

Levophed During Pregnancy and Breastfeeding

During pregnancy, Levophed should be used only if prescribed. It is unknown if this medication passes into breast milk. Consult your doctor before breastfeeding.

How to take Dosage of Norepinephrine (Levophed)?

Norepinephrine (Levophed) should be used exactly as directed by the label or doctor’s instructions. Please do not use more or less of it or for a more extended period than prescribed. This medication is administered via an intravenous infusion given by a healthcare provider. It may have to be taken for several days, depending on how your body responds.

Your vital signs, such as blood pressure and breathing rate, will be continuously monitored during the treatment. If you experience any pain, tingling sensation, coldness, irritation, or other discomfort in the area around the injection site, alert your caregivers right away; norepinephrine could cause damage to the skin and tissue if it leaks out from the vein.

What Happens if Overdose on Norepinephrine (Levophed)?

If you believe someone has overdosed on Norepinephrine (Levophed), immediately contact your doctor or the Poison Control Center. Symptoms of an overdose can include slow heartbeats, a severe headache, excessive sweating, nausea and vomiting, heightened sensitivity to light, pale skin, and sharp chest pains. If someone collapses or stops breathing after taking this medication, call 911 immediately.

General Recommendation

  • Norepinephrine is not advised during pregnancy due to it reducing uterine blood flow.
  • If the patient takes an MAO inhibitor or tricyclic antidepressant, caution should be taken as it can cause severe hypertension.
  • Regular BP monitoring must be done every 2-3 minutes while titrating medication and then every 5-15 minutes when the infusion has been established, depending on facility policy – this would be made more accessible when using an arterial line which can provide real-time data and is more comfortable for patients.
  • It’s also important to monitor urine output to assess organ perfusion
  • and keep a close eye on the IV site to avoid any extravasation that may result in tissue necrosis.
  • When weaning a patient off of norepinephrine, consider using a flush line as part of the process. This helps to reduce the need for “hard-flushes” when turning off medication and prevents sudden drops in blood pressure. For peripheral IVs, withdrawals and discarding aren’t necessary; however, PICC lines may contain up to 2ml (or 8mcg) of norepinephrine, which must be removed slowly and safely. To achieve this, running a slow infusion of normal saline will drip out the remaining medication without affecting blood pressure significantly. Before beginning any procedure, refer to your facility’s protocol regarding flushes, vasoactive drugs, TKO, or flush lines.

Relates FAQs

What Drugs, Substances, or Supplements Interact with Levophed?

If possible, before you receive Levophed, tell your doctor about all your other medicines, especially:

  1. an antidepressant;
  2. blood pressure medication; or
  3. An MAO inhibitor–isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

Norepinephrine vs. epinephrine: what’s the difference?

Norepinephrine is employed in medicine to raise or preserve blood pressure during acute medical incidents leading to reduced blood pressure. Moreover, epinephrine is administered in emergencies to handle allergic reactions and low blood pressure in septic shock and maintain pupil dilation while performing eye surgery.

The adrenal medulla mainly secretes epinephrine as a hormone, although small amounts are also found in nerve fibers as a neurotransmitter. Similarly, noradrenaline is usually synthesized within nerves, but some production also occurs in the adrenal glands. Both norepinephrine and epinephrine are released during the body’s fight-or-flight reaction.

Final Words

Norepinephrine (Levophed) is a potent medication for severe low blood pressure patients. It must be administered carefully and monitored closely, as it can cause serious side effects, including tissue damage or cardiac complications.

When taking norepinephrine, you should talk to your doctor beforehand about potential drug interactions or other risks and be aware of the possible side effects. It is important to remember always to follow your doctor’s instructions and regular medical checkups when taking norepinephrine. Knowing the potential risks and how to monitor yourself can help you get the most out of this medication.


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