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Levophed Drip Protocol

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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

If your doctor has directed you to use this medication for your condition, your doctor or pharmacist may already be aware of any possible drug interactions or side effects and may be monitoring you for them. Do not start, stop, or change dosage of this medicine or any medicine before getting further information from your doctor, healthcare provider or pharmacist first. Isocarboxazid linezolid phenelzine procarbazine selegiline transdermal tranylcypromine norepinephrine has serious interactions with at least 34 different drugs. Norepinephrine has moderate interactions with at least 261 different drugs. Bendroflumethiazide bumetanide chlorothiazide chlorthalidone cyclopenthiazide desmopressin ethacrynic acid eucalyptus furosemide hydrochlorothiazide indapamide methyclothiazide metolazone noni juice sage torsemide in this document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist about all products you use. Keep a list of all your medications with you, and share list with your doctor and pharmacist. Check with your physician if you have health questions or concerns. Aantidote for extravasation ischemia: To prevent sloughing and necrosis in areas where extravasation has taken place, infiltrate areas promptly with 10 - 15 mL of saline solution containing 5 - 10 mg of phentolamine mesylate for Injection. Use a syringe with a fine hypodermic needle, with solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, pallid appearance. This medication contains norepinephrine. Do not take Levarterenol or LEVOPHED if you are allergic to norepinephrine or any ingredients contained in this drug. Keep out of reach of children. In case of overdose, get medical help or contact the Poison Control Center immediately.

* 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

CONTRAINDICATIONS / PRECAUTIONS

Norepinephrine Bitartrate Injection is a concentrated, 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. 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. Visually inspect LEVOPHED for particulate matter and discoloration prior to administration. Do not use solution if its color is pinkish or darker than slightly yellow or if it contains precipitate. Add the content of one LEVOPHED vial or ampule to 1 000 mL of 5% Dextrose Injection, USP or Sodium Chloride Injection solutions that contain 5% Dextrose to produce 4 mcg per mL dilution. Dextrose reduces loss of potency due to oxidation. Administration of saline solution alone is not recommend. Use higher concentration solutions in patients requiring fluid restriction.

* 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

Because of its relatively short half - life of 2. 5 minutes, typically, administration of norepinephrine is by continuous infusion. Fda recommends diluting of concentrated norepinephrine in Dextrose - containing solutions before infusion, providing protection against potential oxidation and subsequent loss of drug potency. Fda recommends explicitly against using saline as sole diluent. Common technique is to start infusion at 8 mcg to 12 mcg per minute and titrate to desired pressure. The average maintenance dose is around 2 to 4 mcg per minute. If possible, infusions of norepinephrine should use tubing separate from blood products. It is highly recommended to infuse norepinephrine through large - bore peripheral intravenous catheters or central venous catheters. Ideally, peripheral infusion should be in upper extremity, preferably through antecubital vein, as this provides the least risk of ischemia secondary to extravasation. Lower extremity veins should be avoided if at all possible as occlusive vascular diseases are more likely to occur in lower extremities. Extravasation into local tissue can cause significant ischemia and subsequent necrosis. Should extravasation be suspect, infusion should stop immediately. Attempts should be made to remove any injected medication. If continuing infusion is necessary, it should be restart at a different site, ideally in different extremity. Local areas should then be infiltrated with phentolamine. It is worth noting that hypotension secondary to hypovolemia should have treatment with fluid resuscitation as priority. Using vasopressors such as norepinephrine in patients who have not had appropriate resuscitation may result in worsening ischemia and an overall decline in clinical status. Visually inspect LEVOPHED for particulate matter and discoloration prior to administration. Do not use solution if its color is pinkish or darker than slightly yellow or if it contains precipitate. Add the content of one LEVOPHED vial or ampule to 1 000 mL of 5% Dextrose Injection, USP or Sodium Chloride Injection solutions that contain 5% Dextrose to produce 4 mcg per mL dilution. Dextrose reduces loss of potency due to oxidation. Administration of saline solution alone is not recommend. Use higher concentration solutions in patients requiring fluid restriction. Prior to use, store diluted LEVOPHED solution for up to 24 hours at room temperature and protect from light.

* 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

PREGNANCY AND LACTATION

Body As Whole: Ischemic injury due to potent vasoconstrictor action and tissue hypoxia. Cardiovascular System: Bradycardia, probably as reflex result of rise in Blood Pressure, arrhythmias. Prolonged administration of any potent vasopressor may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy. If plasma volumes are not correct, hypotension may recur when LEVOPHED is discontinue, or Blood Pressure may be maintained at risk of severe peripheral and visceral vasoconstriction with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible Ischemic injury. Gangrene of extremities has been rarely report. Overdoses or conventional doses in hypersensitive persons cause severe hypertension with violent headache, photophobia, stabbing retrosternal pain, pallor, intense sweating, and vomiting.

* 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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