Vasopressor (Alpha-1 and Beta-1 Agonist) Pregnancy: Use only in life-threatening situations — vasoconstriction reduces placental perfusion

Noradrenaline (Norepinephrine)

Brand names: Noradrenaline acid tartrate (generic)

Adult dose

Dose: 0.01–3 mcg/kg/min IV infusion, titrated to target MAP ≥65 mmHg (septic shock). Usual effective range: 0.1–0.3 mcg/kg/min.

Route: Central IV line (preferred) or peripheral large-bore IV short-term

Frequency: Continuous infusion

Max: Titrate to clinical response — no absolute maximum; >0.5 mcg/kg/min suggests severe disease

First-line vasopressor for septic shock (Surviving Sepsis Campaign). Increases systemic vascular resistance predominantly (alpha-1). Peripheral infusion acceptable short-term in emergency if central access not immediately available.

Paediatric dose

Dose: 0.1 mcg/min/kg

Route: Central IV or IO

Frequency: Continuous infusion

Max: 2 mcg/kg/min

Concentration: Various preparations — dilute in 5% dextrose or NaCl 0.9% mcg/min/ml

Paediatric septic shock: 0.1 mcg/kg/min; titrate. Intraosseous (IO) route acceptable in emergency.

Dose adjustments

Renal

No dose adjustment — adjust to clinical response

Hepatic

No dose adjustment

Paediatric weight-based calculator

Patient weight (kg)

Paediatric septic shock: 0.1 mcg/kg/min; titrate. Intraosseous (IO) route acceptable in emergency.

Clinical pearls

First-line vasopressor in septic shock (SOAP II trial: less arrhythmia vs dopamine)
Target MAP ≥65 mmHg in septic shock (65-TRIAL: individualised higher MAP target not beneficial)
Peripheral extravasation: if occurs, infiltrate area with phentolamine 5–10 mg diluted in saline
Dilute to 4 mg in 50 mL (80 mcg/mL) — standard concentration for weight-based infusion calculation

Contraindications

Hypovolaemia (correct volume deficit first)
Vascular thrombosis (mesenteric/peripheral — relative contraindication with prolonged use)

Side effects

Reflex bradycardia
Peripheral vasoconstriction (ischaemia risk with extravasation)
Hypertension (over-titration)
Renal vasoconstriction
Extravasation necrosis (central line preferred)
Reduced gut perfusion

Interactions

MAOIs — extreme hypertension (absolute contraindication)
Tricyclic antidepressants — enhanced pressor response
Ergot alkaloids — severe peripheral vasoconstriction
Alpha-blockers — opposing vasoconstriction

Monitoring

Arterial line (continuous blood pressure monitoring)
MAP target ≥65 mmHg
Urine output (target >0.5 mL/kg/h)
Lactate clearance
Peripheral perfusion and skin mottling

Reference: BNFc; BNF; Surviving Sepsis Campaign 2021; SOAP II Trial (De Backer et al, NEJM 2010); 65-TRIAL (Lamontagne et al, NEJM 2020). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways