4 mg/4 ml ampoules (IV)

Executive Summary

(July 2, 2023)

Norepinephrine (NE) is used for hemodynamic support frequently as a first-line vasopressor with the exception of anaphylaxis (epinephrine) and post cardiac arrest care (epinephrine). Consider using noradrenaline in combination with inodilator drugs in cardiogenic shock

Adult dose for shock:
0.01-0.3 μg/kg/min IV.

Mechanism of Action and Usage

NE is an endogenous sympathomimetic catecholamine (acts as a hormone and neurotransmitter). It has alpha-1 and beta-1 adrenergic activity, causing arterial vasoconstriction (alpha-1), increased  heart rate (beta-1) and contractility (beta1), thereby increasing systemic blood pressure and coronary blood flow. Clinically alpha effects are greater than beta effects. In short, it has  inoconstrictor effects, and it also mobilizes unstressed venous blood volume.


The following clinical scenarios include NE for hemodynamic support:


Adult dose and Preparation

Adult dose for shock

0.01-3 μg/kg/min IV.



Pediatric dose

Pediatric dose for shock

0.05-2 ug/kg/min IV

Renal, Hepatic, and other adjustments

No adjustments needed. 

Dosage Forms and Brand Names


Central venous access is preferred for infusion, but peripheral use is reasonably safe when taken  appropriate precautions (1, 2). Consider large veins particularly antecubital vein, and using peripheral catheters of at least 20G in caliber.

Emergency Treatment of Extravasation (7)

Pregnancy and Lactation



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