Noradrenaline (Burns Shock — Vasopressor)

Doses in this SPC are expressed as noradrenaline BASE — confirm whether your local product is expressed as base or as the bitartrate salt before calculating an infusion rate. The fetched product (Noradrenaline 0.08 mg/mL solution for infusion) 'should not be diluted before use: it is supplied ready to use' and 'should not be mixed with other medicines'. THIS IS GENERAL VASOPRESSOR POSOLOGY — the SPC states no burns-specific regimen, no burns-specific target and no burns resuscitation context; the burns application on this page is not covered by the source label. Titration target (§4.2): 'There is great individual variation in the dose required to attain and maintain normotension. The aim should be to establish a low normal systolic blood pressure (100 - 120 mm Hg) or to achieve an adequate mean arterial blood pressure (greater than 65 mm Hg - depending on the patient's condition).' 'Manual bolus for priming when initiating an infusion is not recommended.' Caution is required during infusion relay to avoid haemodynamic instability; continuous infusion through a double pump system with an extension set reducing dead-space volume should be encouraged. Blood pressure should be monitored carefully for the duration of therapy, preferably by arterial blood pressure monitoring. Duration: continue until high-dose vasoactive drug support is no longer indicated, at which point decrease the infusion gradually and switch to an infusion of lower concentration — abrupt withdrawal can result in acute hypotension. Example infusion rates from the SPC table for the 0.08 mg/mL product (weight; micrograms/kg/min base; mg/h base; mL/h): 70 kg — 0.05, 0.21, 2.6; 0.1, 0.42, 5.3; 0.25, 1.05, 13.1; 0.5, 2.1, 26.3; 1, 4.2, 52.5; 1.5, 6.3, 78.8. PAEDIATRIC (§4.2, no per-kg paediatric dose stated): 'Noradrenaline (Norepinephrine) is indicated for adults only. The efficacy and safety of Noradrenaline (Norepinephrine) in 50 ml ready to use solution for infusion in children and adolescents has not been established.' HYPOVOLAEMIA (§4.4): noradrenaline is contraindicated in hypotensive patients in whom circulatory collapse is associated with hypovolaemia, except as an emergency measure to maintain supply to the coronary and cerebral arteries until blood volume replacement therapy can be instituted — directly relevant to burns, where plasma volume depletion must be continuously corrected by appropriate water and electrolyte replacement therapy. EXTRAVASATION (§4.4): check the infusion site frequently for free flow; if blanching occurs consider changing the infusion site. For an extravascular leak, stop the infusion and infiltrate the area as quickly as possible with 10 to 15 mL of a physiological salt solution containing 5 to 10 mg of phentolamine mesilate, using a fine needle, injecting locally throughout the cold, hard, pallid area; sympathetic blockade causes immediate local hyperaemic change if infiltrated within 12 hours. US LABEL CROSS-CHECK (different product strength and a per-minute, not per-kg, convention — do not mix the two conventions): initial dosage 8 to 12 micrograms per minute by intravenous infusion, typical maintenance 2 to 4 micrograms per minute, monitoring blood pressure every two minutes until the desired haemodynamic effect is achieved then every five minutes; the US product is diluted (4 mg in 4 mL added to 1,000 mL of 5% dextrose to produce 4 micrograms per mL) and is infused into a large vein rather than being restricted to a central venous catheter. NOTE: the eMC §4.4 text and several US label sections were truncated at the source-fetch limit.