Norepinephrine

Norepinephrine is a peripheral vasoconstrictor (alpha-adrenergic action) and an inotropic stimulator of the heart and dilator of coronary arteries (beta-adrenergic action).

• Norepinephrine bitartrate injection is indicated to raise blood pressure in adult patients with severe, acute hypotension. Norepinephrine bitartrate injection is a catecholamine indicated for restoration of blood pressure in adult patients with acute hypotensive states.

• None. None.contraindicated

Initial dose of 0.25 mL to 0.375 mL (from 8 mcg to 12 mcg of base) per minute, adjust the rate of flow to establish and maintain a low to normal blood pressure (usually 80 mm Hg to 100 mm Hg systolic) sufficient to maintain the circulation of vital organs. ( 2.2 ) The average maintenance dose ranges from 0.0625 mL to 0.125 mL per minute (from 2 mcg to 4 mcg of base). ( 2.2 ) 2.1 Important Dosage and Administration Instructions Correct Hypovolemia Address hypovolemia before initiation of norepinephrine bitartrate injection therapy. If the patient does not respond to therapy, suspect occult hypovolemia [see Warnings and Precautions (5.1) ] . Administration Dilute norepinephrine bitartrate injection prior to use [see Dosage and Administration (2.3) ] . Infuse norepinephrine bitartrate injection into a large vein. Avoid infusions into the veins of the leg in the elderly or in patients with occlusive vascular disease of the legs [see Warnings and Precautions (5.1) ]. Avoid using a catheter-tie-in technique . Discontinuation When discontinuing the infusion, reduce the flow rate gradually. Avoid abrupt withdrawal. 2.2 Dosage After an initial dosage of 8 to 12 mcg per minute via intravenous infusion, assess patient response and adjust dosage to maintain desired hemodynamic effect. Monitor blood pressure every two minutes until the desired hemodynamic effect is achieved, and then monitor blood pressure every five minutes for the duration of the infusion. Typical maintenance intravenous dosage is 2 to 4 mcg per minute.

Tissue Ischemia : Avoid extravasation of norepinephrine bitartrate injection into the tissues, as local necrosis might ensue due to the vasoconstrictive action of the drug. Infuse norepinephrine bitartrate injection into a large vein. To prevent sloughing and necrosis in areas in which extravasation has taken place, the area should be infiltrated as soon as possible with 10 mL to 15 mL of saline solution containing from 5 mg to 10 mg of an adrenergic blocking agent. ( 5.1 ) Hypotension After Abrupt Discontinuation : Sudden cessation of the infusion rate may result in marked hypotension. Reduce the norepinephrine bitartrate injection infusion rate gradually. ( 5.2 ) Cardiac Arrhythmias: Norepinephrine bitartrate injection may cause arrhythmias. Monitor cardiac function in patients with underlying heart disease. ( 5.3 ) Allergic Reactions with Sulfite: Norepinephrine bitartrate injection contains sodium metabisulfite. Sulfite may cause allergic-type-reactions. ( 5.4 ) 5.1 Tissue Ischemia Administration of norepinephrine bitartrate to patients who are hypotensive from hypovolemia can result in severe peripheral and visceral vasoconstriction, decreased renal perfusion and reduced urine output, tissue hypoxia, lactic acidosis, and reduced systemic blood flow despite “normal” blood pressure. Address hypovolemia prior to initiating norepinephrine bitartrate [see Dosage and Administration (2.1) ]. Avoid norepinephrine bitartrate in patients with mesenteric or peripheral vascular thrombosis, as this may increase ischemia and extend the area of infarction.

The following adverse reactions are described in greater detail in other sections: Tissue Ischemia [see Warnings and Precautions (5.1) ] Hypotension [see Warnings and Precautions (5.2) ] Cardiac Arrhythmias [see Warnings and Precautions (5.3) ] The most common adverse reactions are hypertension and bradycardia. The following adverse reactions can occur: Nervous system disorders: Anxiety, headache Respiratory disorders: Respiratory difficulty, pulmonary edema Most common adverse reactions are ischemic injury, bradycardia, anxiety, transient headache, respiratory difficulty, and extravasation necrosis at injection site. (6) To report SUSPECTED ADVERSE REACTIONS, contact Biocon Pharma Inc., at 1-866-924-6266 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Elderly patients may be at greater risk of developing adverse reactions. ( 8.5 ) 8.1 Pregnancy Risk Summary Limited published data consisting of a small number of case reports and multiple small trials involving the use of norepinephrine in pregnant women at the time of delivery have not identified an increased risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. There are risks to the mother and fetus from hypotension associated with septic shock, myocardial infarction and stroke which are medical emergencies in pregnancy and can be fatal if left untreated. ( see Clinical Considerations ). In animal reproduction studies, using high doses of intravenous norepinephrine resulted in lowered maternal placental blood flow. Clinical relevance to changes in the human fetus is unknown since the average maintenance dose is ten times lower ( see Data ). Increased fetal reabsorptions were observed in pregnant hamsters after receiving daily injections at approximately 2 times the maximum recommended dose on a mg/m 3 basis for four days during organogenesis ( see Data ). The estimated background risk for major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S.

Metabolism

Absorption Following initiation of intravenous infusion, the steady state plasma concentration is achieved in 5 min. Distribution Plasma protein binding of norepinephrine is approximately 25%.

Overdosage with norepinephrine bitartrate may result in headache, severe hypertension, reflex bradycardia, marked increase in peripheral resistance, and decreased cardiac output. In case of overdosage, discontinue norepinephrine bitartrate until the condition of the patient stabilizes.

• Jul 13, 1950NDANDA007513Hospira
• Mar 3, 2003ANDAANDA040455Meitheal
• Mar 27, 2012ANDAANDA040859Baxter Hlthcare Corp
• Oct 4, 2018ANDAANDA211242Mylan Labs Ltd
• Oct 18, 2018ANDAANDA211359Sandoz
• Jan 15, 2021NDANDA214313Baxter Hlthcare Corp
• Sep 15, 2022NDANDA215700Inforlife
• Oct 6, 2022NDANDA214628Long Grove Pharms

1. 1Drug Ineffective2,84020%
2. 2Hypotension1,41110%
3. 3Off Label Use1,3279.5%
4. 4Acute Kidney Injury9186.6%
5. 5Multiple Organ Dysfunction Syndrome8436.0%
6. 6Condition Aggravated8165.8%
7. 7Sepsis8125.8%
8. 8Renal Failure7445.3%
9. 9Toxicity To Various Agents7235.2%
10. 10Cardiac Arrest7175.1%
11. 11Cardiogenic Shock6864.9%
12. 12Septic Shock6534.7%
13. 13Death6084.4%
14. 14Respiratory Failure5924.2%
15. 15Pain4923.5%

Recent PubMed references pinned to Norepinephrine as a MeSH major topic. Citations link to pubmed.ncbi.nlm.nih.gov.

• Modelling cognitive outcomes in the UK Biobank: Education, noradrenaline and frontoparietal networks.
  PloS one · 2026 · Bravo-Merodio L, Olley-Williams JA, Russ D, et al.
  PMID 42241456DOI 10.1371/journal.pone.0350452
• Connexin-43-Mediated Gap Junction Coupling Between Adipocytes Regulates Norepinephrine-Induced Ca(2+) Responses in Perivascular Adipose Tissue.
  Cells · 2026 · Kim AR, Jamka J, Jackson WF, et al.
  PMID 42193915DOI 10.3390/cells15100906
• Synergistic chemiluminescence enhancement by a MOF-derived Co(3)O(4)/In(2)O(3) heterojunction for norepinephrine detection.
  Analytica chimica acta · 2026 · Xiao J, Liu Y, Liu J, et al.
  PMID 42108068DOI 10.1016/j.aca.2026.345546
• Effects of noradrenergic blockade on emotional working memory and its neural underpinnings: A randomized, double-blind, placebo-controlled trial.
  Psychoneuroendocrinology · 2026 · Hempel M, Rosada C, Klockgeter J, et al.
  PMID 42090838DOI 10.1016/j.psyneuen.2026.107872
• Vasopressor Regimens and Maternal Core Temperature During Cesarean Delivery: A Randomized, Double‑blind, Non‑inferiority Trial.
  Drug design, development and therapy · 2026 · Tao W, Bao J, Cao H, et al.
  PMID 42077590DOI 10.2147/DDDT.S598964
• Attitudes, opinions and practice patterns regarding anaesthesia providers' use of vasopressors: protocol for a multicentre mixed-methods study.
  BMJ open · 2026 · Janda AM, Mirizzi K, Athavale T, et al.
  PMID 42044967DOI 10.1136/bmjopen-2025-115982
• Physiological super-resolution in situ recording reveals kinetic changes of sympathetic norepinephrine release in heart failure.
  Proceedings of the National Academy of Sciences of the United States of America · 2026 · Liu B, Jiang X, Guo S, et al.
  PMID 42044334DOI 10.1073/pnas.2519828123
• Enterohemorrhagic Escherichia coli O157:H7 responds to norepinephrine gradients by tRNA reprogramming and codon-biased translation of virulence genes.
  mSystems · 2026 · McShane AE, Chan C-K, Chen R, et al.
  PMID 42017662DOI 10.1128/msystems.01418-25

The 10 most recently updated of 838 ClinicalTrials.gov registrations naming Norepinephrine as an intervention. Registration is not evidence of efficacy or safety — reference crosswalk only.

• Hot Flashes and Neurovascular Function in Women
  Recruiting · Interventional · 120 enrolled · Mayo Clinic
  NCT05193968updated 2026-06-12
• The Role of the LC-NA System in Experimental Sleep Fragmentation
  Recruiting · Phase 1 · Interventional · 42 enrolled · Hans-Peter Landolt
  NCT07167316updated 2026-06-12
• Perioperative Immune Function and Clinical Complications in Pancreaduodenectomy
  Completed · Observational · 58 enrolled · Rigshospitalet, Denmark
  NCT04774198updated 2026-06-12
• Angiotensin 2 for AKI After OLT
  Active not recruiting · Phase 4 · Interventional · 30 enrolled · University of California, Los Angeles
  NCT04592744updated 2026-06-12
• Open-Label Safety Study of AXS-14 in Subjects With Fibromyalgia
  Enrolling by invitation · Phase 3 · Interventional · 300 enrolled · Axsome Therapeutics, Inc.
  NCT07637162updated 2026-06-09
• A Comparison of Prolonged Exposure Therapy, Pharmacotherapy, and Their Combination for PTSD
  Active not recruiting · Phase 4 · Interventional · 304 enrolled · University of Pennsylvania
  NCT04961190updated 2026-06-09
• Effect of Pregabalin on Optic Nerve Sheath Diameter in Craniotomy Patients.
  Active not recruiting · Interventional · 100 enrolled · Benha University
  NCT07630753updated 2026-06-08
• Phenotype Guided Vasoactive Medication During Kidney Transplantation
  Not yet recruiting · Phase 4 · Interventional · 255 enrolled · Jennifer Cutler
  NCT07633600updated 2026-06-08
• A Study Following Women in Menopause Treated With a Non-hormonal Therapy for Hot Flashes and Night Sweats
  Completed · Observational · 999 enrolled · Astellas Pharma Global Development, Inc.
  NCT06049797updated 2026-06-05
• Phase 3 Study of Adjunctive Treatment With Seltorexant in Adult and Elderly Participants With Major Depressive Disorder and Insomnia Symptoms
  Recruiting · Phase 3 · Interventional · 752 enrolled · Janssen Research & Development, LLC
  NCT06559306updated 2026-06-05

Frequently asked questions

How does Norepinephrine work?

Norepinephrine is a peripheral vasoconstrictor (alpha-adrenergic action) and an inotropic stimulator of the heart and dilator of coronary arteries (beta-adrenergic action).

What is Norepinephrine used for?

According to FDA labeling, Norepinephrine carries indications including: Norepinephrine bitartrate injection is indicated to raise blood pressure in adult patients with severe, acute hypotension. Norepinephrine bitartrate injection is a catecholamine indicated for restoration of blood pressure in adult patients with acute hypotensive states.. This is a reference summary of labeled uses, not medical advice or a treatment recommendation.

What class of drug is Norepinephrine?

Norepinephrine is classified as Adrenergic and dopaminergic agents, Catecholamine, Adrenergic alpha-Agonists, Adrenergic beta1-Agonists, Arterial Vasoconstriction, Positive Chronotropy, Positive Inotropy.

What are the brand names for Norepinephrine?

Norepinephrine is marketed under brand names including Levophed.

What are the contraindications for Norepinephrine?

Norepinephrine labeling lists contraindications including: None. None.. Always consult the full prescribing information and a clinician.