Noradrenaline (Cardiogenic Shock / Vasopressor)

How it works

It is a predominantly alpha-1 adrenergic agonist causing intense peripheral vasoconstriction, with modest beta-1 activity providing some inotropic and chronotropic support.

Prescribing in practice

• Administer only as a titrated continuous infusion through a central venous catheter wherever feasible, as extravasation causes severe local vasoconstriction and tissue necrosis; manage extravasation promptly with an alpha-blocker such as phentolamine.
• Reserve for use in a critical-care or resuscitation environment with continuous invasive blood-pressure and cardiac monitoring, and correct hypovolaemia before relying on the vasopressor.
• Excessive vasoconstriction can compromise renal, mesenteric and peripheral perfusion and provoke reflex bradycardia or arrhythmia.

Monitoring

Requires continuous invasive arterial blood-pressure, heart-rate and rhythm monitoring with frequent assessment of tissue perfusion, urine output and the infusion site.

Counselling the patient

• Explain to the patient and family that this medicine supports blood pressure and is given via a drip in intensive care.
• Alert the team immediately to any pain, swelling or colour change at the cannula site.

Evidence & guidelines

The SOAP II trial established noradrenaline as the preferred first-line vasopressor over dopamine in shock owing to fewer arrhythmic events, and it is endorsed as first-line in surviving-sepsis and cardiogenic-shock guidance.