From Wikipedia, the free encyclopedia
Therapeutic use of norepinephrine
This article is about the medication. For this substance as a naturally occurring hormone, see
Norepinephrine .
Norepinephrine
Trade names Levarterenol, Levophed, Norepin, other Other names Noradrenaline (R )-(–)-Norepinephrine l-1-(3,4-Dihydroxyphenyl)-2-aminoethanol
AHFS /
Drugs.com
Monograph
License data
Pregnancy category
Routes of administration
Intravenous
ATC code Source
tissues
Locus coeruleus ;
sympathetic nervous system ;
adrenal medulla Target tissues System-wide
Receptors
α1 ,
α2 ,
β1 ,
β3
Agonists
Sympathomimetic drugs ,
clonidine ,
isoprenaline
Antagonists
Tricyclic antidepressants ,
Beta blockers ,
antipsychotics
Metabolism
MAO-A ;
COMT
Legal status
AU :
S4 (Prescription only)
CA :
OTC
UK :
POM (Prescription only)
US :
℞-only
Metabolism
MAO-A ;
COMT
Excretion Urine (84–96%)
4-[(1R )-2-amino-1-hydroxyethyl]benzene-1,2-diol
CAS Number
PubChem
CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
Formula C 8 H 11 N O 3
Molar mass 169.180 g·mol−1 3D model (
JSmol )
Density 1.397±0.06 g/cm3
Melting point 217 °C (423 °F) (decomposes )
Boiling point 442.6 °C (828.7 °F) ±40.0°C
InChI=1S/C8H11NO3/c9-4-8(12)5-1-2-6(10)7(11)3-5/h1-3,8,10-12H,4,9H2/t8-/m0/s1
Y Key:SFLSHLFXELFNJZ-QMMMGPOBSA-N
Y
(verify)
Norepinephrine , also known as noradrenaline , is a
medication used to treat people with very
low blood pressure .
[2] It is the typical medication used in
sepsis if low blood pressure does not improve following
intravenous fluids .
[3] It is the same molecule as the
hormone and
neurotransmitter
norepinephrine .
[2] It is given by
slow injection into a vein .
[2]
Common side effects include headache, slow heart rate, and
anxiety .
[2] Other side effects include an
irregular heartbeat .
[2] If it leaks out of the vein at the site it is being given, norepinephrine can result in
limb ischemia .
[2] If leakage occurs the use of
phentolamine in the area affected may improve outcomes.
[2] Norepinephrine works by binding and activating
alpha adrenergic receptors .
[2]
Norepinephrine was discovered in 1946 and was approved for medical use in the United States in 1950.
[2]
[4] It is available as a
generic medication .
[2]
Medical uses
Norepinephrine is used mainly as a
sympathomimetic drug to treat people in vasodilatory shock states such as
septic shock and
neurogenic shock , while showing fewer adverse side-effects compared to
dopamine treatment.
[5]
[6]
Mechanism of action
It stimulates
α1 and
α2
adrenergic receptors to cause
blood vessel contraction , thus increases
peripheral vascular resistance and resulted in increased
blood pressure . This effect also reduces the blood supply to gastrointestinal tract and kidneys. Norepinephrine acts on
beta-1 adrenergic receptors , causing increase in heart rate and
cardiac output .
[7] However, the elevation in heart rate is only transient, as
baroreceptor response to the rise in blood pressure as well as enhanced
vagal tone ultimately result in a sustained decrease in heart rate.
[8] Norepinephrine acts more on alpha receptors than the beta receptors.
[9]
Names
Norepinephrine is the
INN while noradrenaline is the
BAN .
References
^ Andersen AM (1975).
"Structural studies of metabolic products of dopamine. IV. Crystal and molecular structure of (-)-noradrenaline" . Acta Chemica Scandinavica. Series B . 29 (8): 871–876.
doi :
10.3891/acta.chem.scand.29b-0871 .
PMID
1202890 .
^
a
b
c
d
e
f
g
h
i
j
"Norepinephrine Bitartrate" . The American Society of Health-System Pharmacists.
Archived from the original on 26 March 2017. Retrieved 26 March 2017 .
^ Latifi R (2016).
Surgical Decision Making: Beyond the Evidence Based Surgery . Springer. p. 67.
ISBN
9783319298245 .
Archived from the original on 2017-03-27.
^
Encyclopedia of the Neurological Sciences . Academic Press. 2014. p. 224.
ISBN
9780123851581 .
Archived from the original on 2017-03-27.
^ Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. (March 2017).
"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016" . Critical Care Medicine . 45 (3): 486–552.
doi :
10.1097/CCM.0000000000002255 .
hdl :
10281/267577 .
PMID
28098591 .
S2CID
52827184 . We recommend norepinephrine as the first-choice vasopressor (strong recommendation, moderate quality of evidence).
^ De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, et al. (March 2010).
"Comparison of dopamine and norepinephrine in the treatment of shock" . The New England Journal of Medicine . 362 (9): 779–789.
doi :
10.1056/nejmoa0907118 .
PMID
20200382 .
^ Moore JI (6 December 2012).
Pharmacology (3rd ed.). Springer Science and Business Media. p. 39.
ISBN
9781468405248 . Retrieved 19 November 2017 .
^ Klabunde RE (7 December 2022).
"Circulating Catecholamines" . CV Physiology . Retrieved 2019-02-27 .
^ Pollard S, Edwin SB, Alaniz C (July 2015).
"Vasopressor and Inotropic Management Of Patients With Septic Shock" . P & T . 40 (7): 438–450.
PMC
4495871 .
PMID
26185405 .
External links
α1
Agonists Antagonists
Abanoquil
Ajmalicine
Alfuzosin
Anisodamine
Anisodine
Atiprosin
Atypical antipsychotics (e.g.,
brexpiprazole ,
clozapine ,
olanzapine ,
quetiapine ,
risperidone )
Benoxathian
Beta blockers (e.g.,
adimolol ,
amosulalol ,
arotinolol ,
carvedilol ,
eugenodilol ,
labetalol )
Buflomedil
Bunazosin
Corynanthine
Dapiprazole
Domesticine
Doxazosin
Ergolines (e.g.,
acetergamine ,
ergotamine ,
dihydroergotamine ,
lisuride ,
nicergoline ,
terguride )
Etoperidone
Fenspiride
Hydroxyzine
Indoramin
Ketanserin
L-765,314
mCPP
Mepiprazole
Metazosin
Monatepil
Moxisylyte
Naftopidil
Nantenine
Neldazosin
Niaprazine
Niguldipine
Pardoprunox
Pelanserin
Perlapine
Phendioxan
Phenoxybenzamine
Phentolamine
Phenylpiperazine
antidepressants (e.g.,
hydroxynefazodone ,
nefazodone ,
trazodone ,
triazoledione )
Piperoxan
Prazosin
Quinazosin
Quinidine
Silodosin
Spegatrine
Spiperone
Talipexole
Tamsulosin
Terazosin
Tiodazosin
Tolazoline
Tetracyclic antidepressants (e.g.,
amoxapine ,
maprotiline ,
mianserin )
Tricyclic antidepressants (e.g.,
amitriptyline ,
clomipramine ,
doxepin ,
imipramine ,
trimipramine )
Trimazosin
Typical antipsychotics (e.g.,
chlorpromazine ,
fluphenazine ,
loxapine ,
thioridazine )
Urapidil
WB-4101
Zolertine
α2
Agonists Antagonists
1-PP
Adimolol
Amesergide
Aptazapine
Atipamezole
Atypical antipsychotics (e.g.,
asenapine ,
brexpiprazole ,
clozapine ,
lurasidone ,
olanzapine ,
paliperidone ,
quetiapine ,
risperidone ,
zotepine )
Azapirones (e.g.,
buspirone ,
gepirone ,
ipsapirone ,
tandospirone )
BRL-44408
Buflomedil
Cirazoline
Efaroxan
Esmirtazapine
Fenmetozole
Fluparoxan
Idazoxan
Ketanserin
Lisuride
mCPP
Mianserin
Mirtazapine
NAN-190
Pardoprunox
Phentolamine
Phenoxybenzamine
Piperoxan
Piribedil
Rauwolscine
Rotigotine
Setiptiline
Spegatrine
Spiroxatrine
Sunepitron
Terguride
Tolazoline
Typical antipsychotics (e.g.,
chlorpromazine ,
fluphenazine ,
loxapine ,
thioridazine )
Yohimbine
β