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Levophed Dosing Chart

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Last Updated: 17 October 2020

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General | Latest Info

Norepinephrine Bitartrate Injection is a concentrate, potent drug which must be diluted in dextrose containing solutions prior to infusion. Infusion of LEVOPHED should be given into large vein. Blood volume depletion should always be correct as fully as possible before any vasopressor is administer. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, LEVOPHED can be administered before and concurrently with blood volume replacement. Average Dosage: Add 4 mL ampul of LEVOPHED To 1 000 mL of 5 percent dextrose containing solution. Each mL of this dilution contains 4 mcg of base of LEVOPHED. Give this solution by intravenous infusion. Insert plastic intravenous catheter through suitable bore needle well advanced centrally into the vein and securely fix with adhesive tape, avoiding, if possible, catheter tie - in technique as this promotes stasis. A drip chamber or other suitable metering device is essential to permit accurate estimation of the rate of flow in drops per minute. After observing response to an initial dose of 2 mL to 3 mL per minute, adjust the rate of flow to establish and maintain low normal blood pressure sufficient to maintain circulation to vital organs. In previously hypertensive patients, it is recommended that blood pressure should be raised no higher than 40 mm Hg below preexisting systolic pressure. The average maintenance dose ranges from 0. 5 mL To 1 mL per minute. High Dosage: Great individual variation occurs in the dose required to attain and maintain adequate Blood Pressure. In all cases, dosage of LEVOPHED should be titrated according to the response of the patient. Occasionally, much larger or even enormous daily doses may be necessary if patient remains hypotensive, but occult blood volume depletion should always be suspect and correct when present. Central venous pressure monitoring is usually helpful in detecting and treating this situation. Fluid Intake: degree of dilution depends on clinical fluid volume requirements. If large volumes of fluid are needed at a flow rate that would involve excessive dose of pressure agent per unit of time, solution more diluted than 4 mcg per mL should be used on other hand, when large volumes of fluid are clinically undesirable, concentration greater than 4 mcg per mL may be necessary. Duration of Therapy: infusion should be continued until adequate Blood Pressure and tissue perfusion are maintained without Therapy. Infusions of LEVOPHED should be reduced gradually, avoiding abrupt withdrawal. In some reported cases of vascular collapse due to acute myocardial infarction, treatment was required for up to six days. Infusions of LEVOPHED are usually administered intravenously during cardiac resuscitation. To restore and maintain adequate blood pressure after effective heartbeat and ventilation have been established by other means. Average Dosage: To maintain systemic Blood Pressure during management of cardiac arrest, LEVOPHED is used in the same manner as described under Restoration of Blood Pressure in Acute Hypotensive States.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Warnings

Norepinephrine Bitartrate Injection is a concentrate, potent drug which must be diluted in dextrose containing solutions prior to infusion. Infusion of LEVOPHED should be given into large vein. Blood volume depletion should always be correct as fully as possible before any vasopressor is administer. When, As emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, LEVOPHED can be administered before and concurrently with blood volume replacement. Levophed should be diluted into 5 percent dextrose injection or 5 percent dextrose and sodium chloride injections. These dextrose containing fluids are protection against significant loss of potency due to oxidation. Administration of saline solution alone is not recommend. Whole blood or plasma, if indicated to increase blood volume, should be administered separately. To maintain systemic Blood Pressure during management of cardiac arrest, LEVOPHED is used in the same manner as described under Restoration of Blood Pressure in Acute Hypotensive States. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to use, whenever solution and container permit. Do not use solution if its color is pinkish or darker than slightly yellow or if it contains precipitate. Great individual variation occur in the dose required to attain and maintain adequate blood pressure. In all cases, dosage of LEVOPHED should be titrated according to the response of the patient. Occasionally, much larger or even enormous daily doses may be necessary if patient remains hypotensive, but occult blood volume depletion should always be suspect and correct when present. Central venous pressure monitoring is usually helpful in detecting and treating this situation. Degree of dilution depends on clinical fluid volume requirements. If large volumes of fluid are needed at a flow rate that would involve excessive dose of pressure agent per unit of time, solution more diluted than 4 mcg per mL should be used on other hand, when large volumes of fluid are clinically undesirable, concentration greater than 4 mcg per mL may be necessary. Infusion should continue until adequate Blood Pressure and tissue perfusion are maintained without therapy. Infusions of LEVOPHED should be reduced gradually, avoiding abrupt withdrawal. In some reported cases of vascular collapse due to acute myocardial infarction, treatment was required for up to six days. Infusions of LEVOPHED are usually administered intravenously during cardiac resuscitation. To restore and maintain adequate blood pressure after effective heartbeat and ventilation have been established by other means.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Introduction

Norepinephrine is a sympathomimetic amine which differs from epinephrine by absence of methyl group on nitrogen atom. Norepinephrine Bitartrate is - 3 4 - dihydroxybenzyl alcohol tartrate monohydrate and has the following structural formula: LEVOPHED is supplied in sterile aqueous solution in form of Bitartrate salt to be administered by intravenous infusion following dilution. Norepinephrine is sparingly soluble in water, very slightly soluble in alcohol and ether, and readily soluble in acids. Each mL contains the equivalent of 1 mg base of norepinephrine, sodium chloride for isotonicity, and not more than 2 mg of sodium metabisulfite as an antioxidant. It has a pH of 3 to 4. 5 air in ampuls has been displaced by nitrogen gas.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Pre-Mixed Dopamine

Table

Cat. No.Size
D1442-60SS250 mL
D1482-60SS250 mL

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

The formulas of the active ingredients are:

IngredientsMolecular FormulaMolecular Weight
Hydrous Dextrose USP198.17
Dopamine Hydrochloride189.64
* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

CONTRAINDICATIONS / PRECAUTIONS

Levophed should not be given to patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be complete. If LEVOPHED is continuously administered to maintain blood pressure in the absence of blood volume replacement, following may occur: severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite normal blood pressure, tissue hypoxia, and lactate acidosis. Levophed should also not be given to patients with mesenteric or peripheral vascular thrombosis unless, in the opinion of the attending physician, administration of LEVOPHED is necessary as a life - saving procedure. Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and therefore seem to sensitize the myocardium to action of intravenously administered epinephrine or norepinephrine. Hence, use of LEVOPHED during cyclopropane and halothane anesthesia is generally considered contraindicate because of the risk of producing ventricular tachycardia or fibrillation. The same type of cardiac arrhythmias may result from use of LEVOPHED in patients with profound hypoxia or hypercarbia.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

ADVERSE REACTIONS

Norepinephrine is a vasopressor that is most appropriate for maintaining mean arterial pressure via an increase in systemic vascular resistance after or during appropriate fluid resuscitation. It has some beta activity, making it more suitable than pure alpha 1 agonists in many situations. However, it should still be used cautiously if a patient has poor cardiac function or pulmonary hypertension. Although use of this drug can be life - saving, improper monitoring can lead to malignant hypertension, arrhythmias, or tissue necrosis. Therefore, all members of the interprofessional care team should be highly alert and avoid compliance when utilizing this powerful medication. Clinicians will be prescribing this agent, but pharmacy should verify dosing and check for drug interactions, reporting any concerns to the team. Nursing will be performing administration, and be on the lookout for both systemic adverse effects of issues with administration itself, such as extravasation, and immediately alert clinicians on duty if they see anything noteworthy. The best and safest outcome will occur when critical care and emergency nurses work in concert with clinicians in monitoring patients on this medication for untoward events; interprofessional team approach is best to guide optimal therapeutic results.


CONTRAINDICATIONS

There are no absolute contraindications to administration of norepinephrine. As mentioned above, norepinephrine use may be contraindicate to treating hypotension that is likely secondary to cardiogenic mechanisms. Additionally, for hypotension primarily related to hypovolemia, norepinephrine is probably not the best agent. The Fda does state that its use could be consideration in low volume states, but only as an emergency measure for maintaining coronary or cerebral perfusion pressure while waiting for appropriate volume resuscitation. Generally, use of norepinephrine should be avoided in patients with mesenteric or peripheral vascular thrombosis as subsequent vasoconstriction will increase area of ischemia and infarction. Profound hypoxia or hypercarbia can sensitize the myocardium to unstable arrhythmias, which could be exacerbated or even be initiated by use of norepinephrine - this is also the case with specific anesthetic agents, such as halothane and cyclopropane. Levophed, preparation of norepinephrine, typically used in clinical setting,ss contains sodium metabisulfite, which may cause allergic reactions in susceptible individuals. This effect may be more common in asthmatics. Care is necessary when using norepinephrine concomitantly with monoamine oxidase inhibitors or amitriptyline and imipramine - type antidepressants. The combination of any of these drugs can lead to severe, prolonged hypertension.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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