Noradrenaline (norepinephrine)

How it works

Noradrenaline is a predominantly alpha-adrenergic agonist with some beta-1 activity, producing vasoconstriction to raise systemic vascular resistance and blood pressure with modest cardiac stimulation.

Prescribing in practice

• Extravasation causes severe local vasoconstriction and tissue necrosis, so it must be given through a secure, preferably central, line with vigilance for extravasation.
• It should be administered as a controlled infusion titrated to blood pressure, never as a rapid bolus, ideally with invasive arterial monitoring.
• Doses are expressed as the base; ensure correct preparation and avoid abrupt cessation, which can cause rebound hypotension.

Monitoring

Continuously monitor blood pressure (ideally intra-arterial), heart rate, perfusion and the infusion site for extravasation throughout therapy.

Counselling the patient

• This medicine is given in a closely monitored setting through a drip into a large vein.
• Report any pain, swelling or colour change around the drip site to staff immediately.

Evidence & guidelines

Noradrenaline is recommended as the first-line vasopressor in septic shock by the Surviving Sepsis Campaign and is standard intensive care practice.