Norepinephrine

Brand EcoPharmPlus

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Clinical Pharmacology

Noradrenaline Agetan - adrenomimetic.

Pharmacodynamics

Α agonist_l- and α₂-adrenergic receptors. It slightly excites β₁- and practically does not affect β₂-adrenoreceptors. It has a powerful vasoconstrictor effect, leading to an increase in AD.

Pharmacokinetics

Not absorbed in the digestive tract. When i / v introduction quickly reaches C_max in plasma (within 2–3 min).

It is metabolized in the liver, kidney and blood plasma with the participation of MAO and catechol-O-methyltransferase (COMT) to practically inactive metabolites, which are excreted through the kidneys.

Indications

Acute hypotension accompanying cardiovascular collapse and shock (to restore and maintain blood pressure - IV perfusion).

Composition

1 ml. contains:

Active substance: norepinephrine tartrate monohydrate (in terms of norepinephrine tartrate) 2 mg / ml;

Excipients: sodium chloride; sodium hydroxide or hydrochloric acid (pH = 3.0–4.5); water for injections.

Norepinephrine is marketed under different brands and generic names, and comes in different dosage forms:

Brand name	Manufacturer	Country	Dosage form
Norepinephrine Agetan	EcoPharmPlus	Russia	solution concentrate
Norepinephrine Agetan	Laboratory Agetan	France	ampoules

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Dosage and Administration

Intravenously, preferably in the vein of the elbow.

The concentrate should be diluted in 5% glucose solution or 0.9% sodium chloride solution. Do not mix with other drugs. With the introduction of Noradrenaline Agetan, you need to constantly monitor blood pressure and heart rate.

After diluting the concentrate, the solution should be used within 12 hours.

An individual dose is established depending on the clinical condition of the patient. The initial dose and rate of administration from 0.1 to 0.3 μg / kg / min of norepinephrine tartrate is recommended. The maximum dose and rate of administration used in the treatment of septic and hemorrhagic shock can reach 3–5 μg / kg / min.

Adverse reactions

With the introduction of Noradrenalin Agetan, the following symptoms may occur:

Contraindications

ischemic disorders up to necrosis caused by vasoconstriction and hypoxia of the tissues, as well as due to extravasation;
arrhythmia;
reflex bradycardia;
anxiety;
difficulty breathing;
tremor;
transient headache;
chest or pharyngeal pain;
vegetative reactions - pallor, increased sweating, vomiting, tachycardia. In particularly sensitive patients, an increase in blood pressure may be accompanied by headache, photophobia, stabbing chest pain, pallor of the skin, increased sweating and vomiting.

With prolonged use, dose adjustment is necessary to avoid recurrent hypotension with drug withdrawal.

Carefully:

severe left ventricular failure, acute heart failure, recent myocardial infarction;
simultaneous use of imipramine and triptilin MAO inhibitors (due to the risk of a pronounced and prolonged increase in blood pressure);
development of cardiac arrhythmia symptoms (in this case, a reduction in the dose of the drug is necessary). In case of polymorphic extrasystoles or the development of volleys of extrasystoles, the dose of the drug should be significantly reduced or canceled treatment.

Drug interactions

The main undesirable effects when combined with certain groups of drugs are pharmacodynamic.

When combined with inhaled anesthetic agents, serious ventricular arrhythmias can occur (anxiety of the heart).

When combined with serotonergic and adrenergic antidepressants, as well as derivatives of imipramine and amitriptyline, paroxysmal hypertension may develop with a risk of cardiac arrhythmia due to adreno-blocking effect on the sympathetic nervous system.

The combination of Noradrenaline Agetan with selective and non-selective MAO inhibitors, linezolid, is contraindicated. at the same time there is a synergistic enhancement of the pressor action of norepinephrine, which requires careful medical monitoring.

Pregnancy and Lactation

Pregnancy is not a restriction for the use of Noradrenaline Agetan. At the time of treatment should stop breastfeeding (no experience with the use of the drug in lactating women).