N-Epi Special Precautions

Avoid hypertension: Because of the potency of norepinephrine and because of varying response to pressor substances the possibility always exists that dangerously high blood pressure may be produced with overdoses of this pressor agent. It is desirable, therefore, to record the blood pressure every two minutes from the time administration is started until the desired blood pressure is obtained, then every five minutes if administration is to be continued.
Site of infusion: Whenever possible, infusions of norepinephrine should be given into a large vein, particularly an antecubital vein because when administered into this vein the risk of necrosis of the overlying skin from prolonged vasoconstriction is apparently very slight. Femoral vein can also be used. A catheter tie-in technique should be avoided, if possible since the obstruction to blood flow around the tubing may cause stasis and increased local concentration of the drug. Occlusive vascular diseases are more likely to occur in the lower than in the upper extremity. Therefore, one should avoid the veins of the leg in elderly patients or in those suffering from such disorders.
Extravasation: The infusion site should be checked frequently for free flow. Care should be taken to avoid extravasation of norepinephrine into the tissues, as local necrosis might ensue due to the vasoconstrictive action of the drug. To prevent sloughing and necrosis in areas in which extravasation has taken place, the area should be infiltrated as soon as possible with 10 ml to 15 ml of saline solution containing from 5 mg to 10 mg of phentolamine mesylate for injection USP, an adrenergic blocking agent. A syringe with a fine hypodermic needle should be used, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, and pallid appearance. Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours. Therefore, phentolamine should be given as soon as possible after the extravasation is noted.
Preexisting hyperthyroidism or hypertension: Because norepinephrine could exacerbate the underlying condition.
Use in Children: Safety and effectiveness in pediatric patients have not been established.