Medication 7-647 - Norepinephrine (Levophed)

CMH EMS & MIH Protocols

Scope of Practice:

• Registered Nurse
• Paramedic
• Community Paramedic

Route(s):

• IO, IV,

Pharmacodynamics (class and mechanism of action):

• Sympathomimetic amine. (Stimulates α (alpha) and β (beta) adrenergic receptors. Increases cardiac contractility. Causes peripheral vasoconstriction. Limited chronotropic effects.).

Pharmacokinetics:

• Half-life: 1-2 minutes.
• Onset time: 1-2 minutes.
• Peak action time: 10 minutes.
• Duration of action: 20-60 minutes.

• Peak	4	8	12	16	20	24	28	32	36	40	44	minutes
  Duration	4	8	12	16	20	24	28	32	36	40	44	minutes

Dosing:

• Refer to specific protocol(s) below for dose(s).

Indications:

• Protocol 2-583 - Hypotension / Shock

Contraindications:

• Allergies to sulfa.
• Patients taking MAOIs or triptyline/imipramine antidepressants.
• Hypotension due to hypovolemia (trauma or dehydration).

Pregnancy Risk Factor:

• Category C
• Risk not ruled out: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. FDA requires a relatively large amount of high-quality data on a pharmaceutical for it to be defined as Pregnancy Category A. As a result of this, many drugs that would be considered Pregnancy Category A in other countries are allocated to Category C by the FDA.

Potential Incompatibilities:

• None.

Precautions and Adverse Effects:

• Only administer through at least an 18 gauge IV in the AC space or more proximal location. An IO, PICC, or Port may also be used.
• May cause ischemic injury due to vasoconstriction, Bradycardia, arrhythmias, Anxiety, headaches, Respiratory Difficulty, and/or extravasation necrosis at injection site.

Antidote:

• Rigitine.

Controlled Substance Information:

• Not a scheduled drug
• The DEA and FDA have not identified this drug with a schedule classification.
• DEA number: NA.
• Narcotic: No.
• Street names: NA.

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CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."

Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.