Noradrenaline

Alpha/Beta Agonist·Cardiovascular - Vasopressors & ICU

Septic shock, cardiogenic shock, profound hypotension

VASOPRESSORLevophedS4TGA

Max Dose

Variable

Half-life

2.5 mins

Ischaemia

RISK

Route

IV CENTRAL

Rapid Summary

Overview

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

Maximum Dose

Max varies entirely by clinical response. Escalating doses reflect profound shock state.

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.

Avoid / Cautions

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

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

Noradrenaline

Alpha/Beta Agonist·Cardiovascular - Vasopressors & ICU

Septic shock, cardiogenic shock, profound hypotension

VASOPRESSORLevophedS4TGA

Max Dose

Variable

Half-life

2.5 mins

Ischaemia

RISK

Route

IV CENTRAL

Rapid Summary

Overview

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

Maximum Dose

Max varies entirely by clinical response. Escalating doses reflect profound shock state.

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.

Avoid / Cautions

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

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