Hyponor

Indication
Acute Hypotension, Cardiac Arrest, Sepsis & Septic Shock

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Administration
IV Preparation & Administration Infuse using a solution of 4 mcg/ml in glucose 5%, or sodium chloride 0.9% and glucose 5% at a rate of 2-3 ml/minute. Adjust according to BP response. Average maintenance dose: 0.5-1 ml/minute (2-4 mcg/minute). Infuse via a central venous catheter or into a large vein.

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Adult Dose
Intravenous Adult: Acute Hypotension, Cardiac Arrest Initial: 8-12 mcg/min IV infusion; titrate to effect Maintenance: 2-4 mcg/min IV infusion Sepsis & Septic Shock 0.01-3 mcg/kg/min IV infusion

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Child Dose
Child: Acute Hypotension, Cardiac Arrest Initial: 0.05-0.1 mcg/kg/min IV infusion; titrate to effect Maximum: 1-2 mcg/kg/min Shock 0.05-0.1 mcg/kg/min IV infusion; titrate to effect; not to exceed 2 mcg/kg/min

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Contraindication
Hypersensitivity. Hypertension. Pregnancy. Patients with peripheral or mesenteric vascular thrombosis unless necessary as a life-saving procedure. Concomitant use with some general anesthetics: Chloroform, trichloroethylene, cyclopropane, halothane

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Mode of Action
Norepinephrine is a direct-acting sympathomimetic which stimulates alpha 1- and beta-adrenergic receptors. Its alpha-agonist effects cause vasoconstriction, thereby raising systolic and diastolic BP with reflex slowing of heart rate.
Precaution
Not a substitute for replacement of blood, plasma, fluids, and/or electrolytes; correct volume depletion prior to admin. Identify and correct hypoxia, hypercapnia and acidosis prior to or during admin. Avoid extravasation as tissue necrosis may occur. Avoid inj into leg veins, especially in elderly or those with occlusive vascular diseases, arteriosclerosis, DM or Buerger’s disease. Hypertensive or hyperthyroid patients. In conjunction with local anaesthetics, do not use in fingers, toes, ears, nose or genitalia. Lactation. Lactation: Not known if excreted into breast milk; avoid use during breastfeeding

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Side Effect
Hypertension, headache, peripheral ischaemia, bradycardia, arrhythmias, anxiety, skin necrosis (with extravasation), dyspnoea, respiratory difficulty.
Interaction
Guanethidine, methyldopa, reserpine, TCAs may increase pressor response to norepinephrine. Potentially Fatal: Increased risk of arrhythmias with cocaine, cyclopropane or halogenated hydrocarbon anaesthetics. Hypertensive crisis may occur with MAOIs. Hypertensive effects may be increased by nonselective β-blockers.

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