Vasopressors and inotropes
Norepinephrine (Levophed) drip
Levophed
Watch the explainer
Dosing
| Start | 2–12 mcg/min (about 0.02–0.15 mcg/kg/min) |
|---|---|
| Titrate | 1–2 mcg/min (0.01–0.05 mcg/kg/min) every 5 minutes to the MAP goal |
| Maximum | No fixed maximum. Rising past about 0.25–0.5 mcg/kg/min: add vasopressin (SSC 2021; SSC 2026 sets no threshold) |
| Common bags | 4 mg in 250 mL (16 mcg/mL); 8 mg in 250 mL (32 mcg/mL); 16 mg in 250 mL (64 mcg/mL) |
| Dose units | mcg/min, mcg/kg/min |
Line and administration
- Central line preferred; peripheral is acceptable short term in a large proximal arm vein with frequent site checks
- Extravasation: stop, aspirate, phentolamine 5–10 mg in 10–15 mL saline injected into the area
Watch for
- Arrhythmias
- Digital, limb and gut ischemia
- Treat hypovolemia alongside
Norepinephrine: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Norepinephrine: α1 > β1 (little β2): ↔ / ↑ / ↑↑
- Shock Types at a GlanceFindings and first treatments: Cardiogenic: Cool, mottled; crackles, JVD; low urine output: Reperfuse an MI; norepinephrine; add an inotrope; MCS if failing
- Pulmonary EmbolismSupporting the failing RV: Norepinephrine first: keeps aortic above RV pressure; vasopressin second
- Prehospital SepsisVasopressors in transport: First line: Norepinephrine
- Spinal Motion RestrictionCord injury: breathing and shock: Paramedic/ED: cautious fluids, then a vasopressor; norepinephrine preferred (alpha and beta)
- Obstetric EmergenciesAmniotic fluid embolism: Right heart failure: echo, 500 mL boluses with reassessment, norepinephrine, adding dobutamine 2.5–5 or milrinone 0.25–0.75 mcg/kg/min
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.