Alpha/Beta Agonist·Cardiovascular - Vasopressors & ICU

Noradrenaline

Septic shock, cardiogenic shock, profound hypotension

VASOPRESSORLevophedS4TGA

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

Variable

Caution: Half-life

2.5 mins

High risk: Ischaemia

RISK

Route

IV CENTRAL

Cautions

Avoid / Cautions

Hypovolemia (must restore fluid volume first), mesenteric/peripheral vascular thrombosis. Pregnancy Category B3. Reduces placental perfusion.

Where it stands

Rapid Summary

Overview

The gold-standard vasopressor. Potent alpha-1 agonist causing intense vasoconstriction to elevate blood pressure in shock.

Clinical Focus

Requires a central venous catheter (CVC) due to the severe risk of tissue necrosis if extravasation occurs via a peripheral line.

Bottom Line

Noradrenaline is the first-line vasopressor for septic shock and ICU haemodynamic support, but must be given via central line as peripheral extravasation causes tissue necrosis.

Formulation & Access

Brand Names

Levophed

Parenteral

Ampoules (4 mg/4 mL or 8 mg/8 mL) requiring dilution in D5W or Normal Saline.

Prescribing & PBS

Restricted. ICU/OT supply only.

Indications & Use

Primary

TGA

Septic shock, cardiogenic shock, profound hypotension.

Clinical Place

First-line vasopressor in ICU for almost all forms of shock.

Quick reference

Class & Role

Alpha/Beta Agonist — The gold-standard vasopressor.

Route / Formulation

Ampoules (4 mg/4 mL or 8 mg/8 mL) requiring dilution in D5W or Normal Saline. (Levophed)

Usual Dose & Max

IV Infusion Start at 0.05 - 0.1 mcg/kg/min via CVC. Titrate strictly to target MAP (usually > 65 mmHg). Max varies entirely by clinical response. Escalating doses reflect profound shock state.

Key Indication Doses

Distributive Shock (Sepsis): IV Infusion Start at 0.05 - 0.1 mcg/kg/min via CVC. Titrate strictly to target MAP (usually > 65 mmHg). Peripheral Emergency: In extreme emergencies, dilute preparations can be run peripherally for a very short time while awaiting CVC insertion.

Best Uses

Noradrenaline is the first-line vasopressor for septic shock and ICU haemodynamic support, but must be given via central line as peripheral extravasation causes tissue necrosis.

Key Risks

Cardiovascular: Severe hypertension, reflex bradycardia, peripheral and mesenteric ischaemia, arrhythmias. Tissue: Extravasation causes profound local vasoconstriction, leading to gangrene and limb loss.

Key Interactions

MAOIs and TCAs massively potentiate the pressor effects, leading to hypertensive crisis.

Monitoring

Intra-arterial BP line. Strict IV site checks if run peripherally. Monitor ABGs (lactate clearance).

Clinical Pearl

If noradrenaline extravasates into tissue, immediately infiltrate the area with Phentolamine (an alpha-blocker) to reverse the severe vasoconstriction and save the limb.

Access

Levophed

Brand: Levophed

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

Alpha/Beta Agonist·Cardiovascular - Vasopressors & ICU

Noradrenaline

Septic shock, cardiogenic shock, profound hypotension

VASOPRESSORLevophedS4TGA

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

Variable

Caution: Half-life

2.5 mins

High risk: Ischaemia

RISK

Route

IV CENTRAL

Cautions

Avoid / Cautions

Hypovolemia (must restore fluid volume first), mesenteric/peripheral vascular thrombosis. Pregnancy Category B3. Reduces placental perfusion.

Where it stands

Rapid Summary

Overview

The gold-standard vasopressor. Potent alpha-1 agonist causing intense vasoconstriction to elevate blood pressure in shock.

Clinical Focus

Requires a central venous catheter (CVC) due to the severe risk of tissue necrosis if extravasation occurs via a peripheral line.

Bottom Line

Noradrenaline is the first-line vasopressor for septic shock and ICU haemodynamic support, but must be given via central line as peripheral extravasation causes tissue necrosis.

Formulation & Access

Brand Names

Levophed

Parenteral

Ampoules (4 mg/4 mL or 8 mg/8 mL) requiring dilution in D5W or Normal Saline.

Prescribing & PBS

Restricted. ICU/OT supply only.

Indications & Use

Primary

TGA

Septic shock, cardiogenic shock, profound hypotension.

Clinical Place

First-line vasopressor in ICU for almost all forms of shock.

Quick reference

Class & Role

Alpha/Beta Agonist — The gold-standard vasopressor.

Route / Formulation

Ampoules (4 mg/4 mL or 8 mg/8 mL) requiring dilution in D5W or Normal Saline. (Levophed)

Usual Dose & Max

IV Infusion Start at 0.05 - 0.1 mcg/kg/min via CVC. Titrate strictly to target MAP (usually > 65 mmHg). Max varies entirely by clinical response. Escalating doses reflect profound shock state.

Key Indication Doses

Best Uses

Noradrenaline is the first-line vasopressor for septic shock and ICU haemodynamic support, but must be given via central line as peripheral extravasation causes tissue necrosis.

Key Risks

Key Interactions

MAOIs and TCAs massively potentiate the pressor effects, leading to hypertensive crisis.

Monitoring

Intra-arterial BP line. Strict IV site checks if run peripherally. Monitor ABGs (lactate clearance).

Clinical Pearl

If noradrenaline extravasates into tissue, immediately infiltrate the area with Phentolamine (an alpha-blocker) to reverse the severe vasoconstriction and save the limb.

Access

Levophed

Brand: Levophed

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.