Indications (PNDF / clinical use):

For acute hypotensive states and shock when vasopressor support is required, including: septic (vasodilatory) shock after adequate fluid resuscitation, cardiogenic shock (to raise perfusion pressure), neurogenic shock, persistent hypotension after cardiac arrest, and other life-threatening hypotension requiring vasoactive support. 

Dosage & Administration:

Adults:

• Typical initial infusion: 8–12 µg/min (many protocols use this starting range and titrate).
• Maintenance range (commonly): 2–4 µg/min, titrate to target MAP (often MAP ≥ 65 mmHg).
• Dosing may also be weight-based in some protocols (e.g., 0.05–0.5 µg/kg/min) and higher doses are used in refractory shock under specialist care. 

Children:

• Dosing is specialist-directed; typical pediatric/neonatal dosing is lower and weight-based — follow unit guidelines or product PI. 

Important: Titrate rapidly to effect and monitor continuously (invasive arterial BP when possible).

Reconstitution & Infusion Preparation (from 1 mg/mL ampoule):

• Common hospital dilutions / examples:
  • Add 4 mL (4 mg) to 250 mL D5W or 0.9% NaCl → final concentration ≈ 16 µg/mL (norepinephrine base) — convenient for infusion rate calculations (this is a commonly used dilution in many protocols). 
  • Alternative dilutions: 4 mg in 500 mL (≈8 µg/mL) or other concentrations per local protocol/institutional infusion charts.
• Administration: Continuous IV infusion using an infusion pump or syringe pump. Central venous access preferred; if peripheral line used, monitor the site closely for extravasation. 

Contraindications:

• Hypotension due to hypovolemia (unless intravascular volume is corrected).
• Known hypersensitivity to norepinephrine or excipients (some formulations contain sulfites). 

Precautions:

• Continuous hemodynamic monitoring (arterial BP) is recommended.
• Use caution in patients with coronary artery disease, peripheral vascular disease, hyperthyroidism, or arrhythmias — risk of ischemia/arrhythmia with vasoconstrictors.
• Avoid abrupt cessation (titrate down gradually where possible).
• If extravasation occurs: stop infusion, aspirate drug, and treat per local protocol (e.g., local infiltration with phentolamine if available). 

Adverse Reactions:

• Hypertension, reflex bradycardia, tachyarrhythmias, myocardial ischemia, peripheral ischemia/necrosis with extravasation, headache, anxiety.
• High doses can reduce splanchnic and renal perfusion — monitor end-organ function.

Pregnancy Category (PNDF Reference):

Category C – Risk cannot be ruled out; use only if potential benefit outweighs potential risk.