N-Epi Adverse Reactions

Serious adverse reactions: Cardiovascular: Cardiac arrest, Cardiac arrhythmia. Cardiac arrhythmias may arise when norepinephrine is used in conjunction with cardiac sensitising agents, and may be more likely in patients with hypoxia or hypercarbia.
Common adverse reactions: Cardiovascular: Hypertension may occur, which may be associated with bradycardia as well as headache and peripheral ischemia, including gangrene of the extremities.
Dermatologic: Extravasation of norepinephrine, especially with repeated injections or high infusion rates, can result in severe tissue damage and necrosis.
Gastrointestinal: Nausea, Vomiting.
Neurologic: Confusion, Headache, Tremor.
Psychiatric: Anxiety, Restlessness.
Renal: Urinary retention.
Respiratory: Dyspnea, respiratory difficulty.
CNS: Anxiety, transient headache.
Miscellaneous: Ischemic injury due to potent vasoconstrictor action and tissue hypoxia.
Prolonged administration may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy, if plasma volumes are not corrected. Hypotension may recur when norepinephrine bitartrate injection is discontinued or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g. decreased renal perfusion) with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury. Gangrene of extremities has been rarely reported.
Overdoses or conventional doses in hypersensitive persons (e.g. hyperthyroid patients) cause severe hypertension with violent headache, photophobia, stabbing retrosternal pain, pallor, intense sweating and vomiting.