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Levophed Drip Rate

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Last Updated: 19 October 2020

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General | Latest Info

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.

* 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 therapy is continuously administered to maintain Blood Pressure in absence of blood volume replacement, severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite normal Blood Pressure, tissue hypoxia, and lactate acidosis may occur using extreme caution with concurrent monoamine oxidase inhibitor use or antidepressants of triptyline or imipramine types; severe, prolonged hypertension may result cyclopropane and halothane anesthetics increase cardiac autonomic irritability and seem To sensitize myocardium To action of intravenously administer epinephrine or norepinephrine Bitartrate Injection contain sodium metabisulfite, Sulfite that may cause allergic - type reactions including anaphylactic symptoms and life - threatening or less severe asthmatic episodes in certain susceptible people because of potency of drug and because of varying response To pressor substances, possibility always exist that dangerously high Blood Pressure may be produce with overdoses of this pressor agent; it is desirable, therefore, To record Blood Pressure every two min from time administration is start until desire Blood Pressure is obtain, then every five min if administration is To be continue; rate of flow must be watch constantly, and patient should never be leave unattended while receiving therapy; headache may be symptom of hypertension due To overdosage when possible, infusions should be give into large vein, particularly antecubital vein To reduce risk of necrosis of overlying skin from prolonged vasoconstriction; some authors have indicate that femoral vein is acceptable route of administration; occlusive vascular diseases are more likely To occur in lower than in upper extremity; one should avoid veins of leg in elderly patients or in those suffering from such disorders; gangrene has been report in lower extremity when infusions were give in ankle vein infusion site should be check frequently for free flow; care should be take To avoid Extravasation of drug into tissues, As local necrosis might ensue due To vasoconstrictive action of drug; blanching along course of infused vein, sometimes without obvious Extravasation, has been attribute To vasa vasorum constriction with increased permeability of vein wall, permitting some leakage To prevent sloughing and necrosis in areas in which Extravasation has take place, area should be infiltrate As soon As possible with 10 - 15 mL of saline solution containing from 5 mg To 10 mg of Regitine, adrenergic blocking agent; syringe with fine hypodermic needle should be use, with solution being infiltrate liberally throughout area, which is easily identify by its cold, hard, and pallid appearance; sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if area is infiltrate within 12 hours; therefore, phentolamine should be give As soon As possible after Extravasation is note.

* 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

Table

2mcg8gtts/min
4mcg15gtts/min
6mcg23gtts/min
8mcg30gtts/min
10mcg38gtts/min
12mcg45gtts/min

Vasoactive medications are indicated when Systolic Blood Pressure has decreased to > 30mmHg from baseline or Mean Arteriole Pressure less than 60 - 65mmHg and when either condition results in end - organ dysfunction due to hypoperfusion. Additionally, Vasoactive medications are used for management of hypertensive crisis, flash pulmonary edema, sepsis, shock States, atrial fibrillation with rapid ventricular Response, supraventricular tachycardia, heart failure, and hemodynamically unstable patients. Vasopressors should be infused via central access but can be administered peripherally until central access is obtain. All Vasoactive drips can cause severe tissue injury if infiltration occur. It should also be considered to have arterial line pressure monitoring for patients on Vasoactive drips. A Physician's order is needed to administer any Vasoactive drip, and the order should include parameters for titrate relating to heart rate, blood pressure, respiratory rate, and oxygen saturation if indicate. Healthcare providers must know maximum dose, minimum dose, titration parameters, and side effects for all critical care drips and infusions. Remember that cardiac output is the holy grail of hemodynamics. To maintain blood pressure and heart rate, cardiac output must be sustain. Cardiac output is defined by stroke volume times heart rate. Cardiac output is a vital part of oxygen delivery, blood pressure, urine output, and perfusion. There are many drugs used for hemodynamic instability, cardiogenic shock, and neurogenic shock. Norepinephrine, epinephrine, phenylephrine, vasopressin, dopamine, and dobutamine are a few of the medications used. Volume loss and hypovolemia should be corrected before administration of any vasopressor. If fluid status is unknown, then continue close hemodynamic monitoring to determine the efficacy of Vasoactive drip. 1 Vasoactive drips will only temporarily correct hypovolemia, and then the patient will become unstable again until the fluid volume status of the patient is correct. All critical care drips must be on infusion pump. All patients on Vasoactive medications must be on continuous heart monitor, along with blood pressure and oxygen saturation monitoring. Emergency resuscitative equipment and medications should always be immediately available to manage any unwanted medication reactions.

* 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.

Table2

2mcg4gtts/min
4mcg8gtts/min
6mcg11gtts/min
8mcg15gtts/min
10mcg19gtts/min
12mcg23gtts/min
* 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

Levophed is a potent alpha / beta - agonist causing vasoconstriction and an increase in blood pressure. It is used for severe hypotension, shock, or bradycardia. Mix 4mg Levophed in 250ml of D5W, making a drip of 16mcg / ml. The standard effective dose is 2 - 12 micrograms / min. This drug has rapid onset and a short half - life. Drips usually start at 2 mcg / min or 7. 5 ml / hr and titrate up for effect or until blood pressure becomes normotensive with MAP 60 - 65mmHg and / or SBP > 90. Vital signs are monitored continuously and documented every 5 minutes during titration. 54 y / o male presents to ER with complaint of feeling weak and dizzy. He has a history of gout, diabetes, GERD, and psoriasis. He is allergic to sulfa. His glucose is 96. He is pale, clammy, and lethargic. His vital signs are heart rate of 101, blood pressure 78 / 50, oxygen saturation 94%, temperature 97. 8, and respirations of 24. 16g peripheral IV is establish, ECG is complete, and oxygen therapy 3L Nasal Cannula is start. After 3 liters of normal saline, his blood pressure is 80 / 40. Which medication should doctor order? Dopamine Dobutamine Levophed Diltiazem Levophed is an alpha / beta - agonist, causing vasoconstriction and an increase in blood pressure. It is used for severe hypotension, shock, or bradycardia. Dopamine and Dobutamine are contraindicate with Sulfite allergy. The physician orders Levophed drip to be started at 0. 5 mcg / min with parameters in order to keep SBP > 90 and heart rate less than 120. After 20 min, patient's vital signs are heart rate of 106, B / P 88 / 42, saturation of 96%. What is the next titration? 10 mcg / min 5 mcg / min 3 mcg / min 1 mcg / min Levophed has rapid onset and short half - life. Incremental increases in drip will improve blood pressure rapidly. Monitor vital signs every 5 minutes and increase drip again after 20 minutes if necessary, to meet parameters.

* 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

Dobutamine

Dobutamine may interact with beta - blockers and nitroprusside. Tell your doctor all the medications and supplements you use. Dobutamine should be used during pregnancy only if clearly needed. It is unknown if Dobutamine passes into breast milk. If mother requires Dobutamine treatment, breastfeeding should be discontinued for the duration of treatment. Levophed may interact with blood pressure medications, MAO inhibitors, or antidepressants. Tell your doctor all the medications you use. During pregnancy, Levophed should be used only if prescribe. It is unknown if this medication passes into breast milk. Consult your doctor before breastfeeding. The usual adult dosage of Dobutamine ranges from 50 to 200 g in a 24 - hour period, but in most instances, adequate response will be achieved at dosage of approximately 100 g / 24 hours. Levophed is diluted in liquid and give continuously into large vein, as directed by the doctor. Dosage is based on the patient's condition and response to treatment.

* 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

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.


DOSAGE AND ADMINISTRATION

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.

* 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

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. 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

ADVERSE REACTIONS

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

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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