Respiratory disorders: Respiratory difficulty, pulmonary edema DRUG INTERACTIONS MAO-Inhibiting DrugsĬo-administration of LEVOPHED with monoamine oxidase (MAO) inhibitors or other drugs with MAO-inhibiting properties (e.g., linezolid) can cause severe, prolonged hypertension. Nervous system disorders: Anxiety, headache The following adverse reactions can occur: The most common adverse reactions are hypertension and bradycardia. The following adverse reactions are described in greater detail in other sections: Revised: Oct 2020 SLIDESHOW Low Blood Pressure (Hypotension): Symptoms, Signs, Causes See Slideshow Discard unused portion.ĭistributed by Hospira, Inc., Lake Forest, IL 60045 USA. Store in original carton until time of administration to protect from light. It is available as 4 mg/4 mL in single-dose amber glass vials and in single-dose clear glass ampules. It contains the equivalent of 1 mg of norepinephrine base per 1 mL (4 mg/4 mL). LEVOPHED (norepinephrine bitartrate) injection, USP, is a sterile, colorless solution for injection intended for intravenous use. InjectionĤ mg/4 mL (1 mg/mL norepinephrine base) sterile, colorless solution in a single-dose clear glass ampule. HOW SUPPLIED Dosage Forms And Strengths InjectionĤ mg/4 mL (1 mg/mL norepinephrine base) sterile, colorless solution in a single-dose amber glass vial. Whole blood or plasma, if indicated to increase blood volume, should be administered separately. Drug IncompatibilitiesĪvoid contact with iron salts, alkalis, or oxidizing agents. Prior to use, store the diluted LEVOPHED solution for up to 24 hours at room temperature and protect from light. Use higher concentration solutions in patients requiring fluid restriction. Administration in saline solution alone is not recommended. Dextrose reduces loss of potency due to oxidation. Do not use the solution if its color is pinkish or darker than slightly yellow or if it contains a precipitate.Īdd the content of one LEVOPHED vial or ampule (4 mg in 4 mL) to 1,000 mL of 5% Dextrose Injection, USP or Sodium Chloride Injection solutions that contain 5% dextrose to produce a 4 mcg per mL dilution. Visually inspect LEVOPHED for particulate matter and discoloration prior to administration (the solution is colorless). Typical maintenance intravenous dosage is 2 to 4 mcg per minute. Monitor blood pressure every two minutes until the desired hemodynamic effect is achieved, and then monitor blood pressure every five minutes for the duration of the infusion. DosageĪfter an initial dosage of 8 to 12 mcg per minute via intravenous infusion, assess patient response and adjust dosage to maintain desired hemodynamic effect. When discontinuing the infusion, reduce the flow rate gradually. Avoid infusions into the veins of the leg in the elderly or in patients with occlusive vascular disease of the legs. Administrationĭilute LEVOPHED prior to use. If the patient does not respond to therapy, suspect occult hypovolemia. DOSAGE AND ADMINISTRATION Important Dosage And Administration Instructions Correct HypovolemiaĪddress hypovolemia before initiation of LEVOPHED therapy. LEVOPHED is indicated to raise blood pressure in adult patients with severe, acute hypotension. The air in the ampuls has been displaced by nitrogen gas. 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. Norepinephrine is sparingly soluble in water, very slightly soluble in alcohol and ether, and readily soluble in acids. LEVOPHED is supplied in sterile aqueous solution in the form of the bitartrate salt to be administered by intravenous infusion following dilution. Norepinephrine Bitartrate is (-)-α-(aminomethyl)-3,4-dihydroxybenzyl alcohol tartrate (1:1) (salt) monohydrate and has the following structural formula: Norepinephrine (sometimes referred to as l-arterenol/Levarterenol or l-norepinephrine) is a sympathomimetic amine which differs from epinephrine by the absence of a methyl group on the nitrogen atom.
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