α/β adrenergic agonist (predominantly α1)

Noradrenaline (norepinephrine)

Adult dose

Dose: Septic/distributive shock: 0.05–1 microgram/kg/min IV continuous infusion via central line, titrated to MAP ≥65

Route: IV (central preferred)

Frequency: continuous

Clinical pearls

First-line vasopressor in septic shock (NICE NG51 / Surviving Sepsis Campaign)
Central venous administration preferred — short peripheral course acceptable in dilute concentration as bridge
Phentolamine 5–10mg in 10–15mL saline locally for extravasation

Contraindications

Hypovolaemic shock without volume resuscitation
Mesenteric/peripheral vascular thrombosis (caution)
Hypoxia/hypercapnia
Cyclopropane/halothane anaesthesia

Side effects

Tissue ischaemia (extravasation — phentolamine)
Arrhythmia
Reflex bradycardia
Hyperglycaemia
Anxiety/headache

Interactions

MAOIs (severe hypertension)
TCAs
Volatile anaesthetics
β-blockers

Monitoring

Continuous BP
ECG
Lactate
Urine output
Limb perfusion

Reference: BNF; Surviving Sepsis Campaign; NICE NG51; https://bnf.nice.org.uk/drugs/noradrenalinenorepinephrine/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways