Norepirin Special Precautions

Norepinephrine bitartrate injection should be used with extreme caution in patients receiving monoamine oxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine types, because severe prolonged hypertension may result.
Assure adequate circulatory volume to minimize need for vasoconstrictors.
Avoid hypertension; monitor blood pressure closely and adjust infusion rate.
Use in patients with profound hypoxia or hypercarbia may produce ventricular tachycardia or fibrillation; use with extreme caution.
Vesicant; ensure proper needle or catheter placement prior to and during infusion.
Avoid extravasation; infuse into a large vein if possible. Avoid infusion into leg veins. Monitor IV site closely.
If extravasation occurs, infiltrate the area with diluted phentolamine (5 to 10 mg in saline) with a fine hypodermic needle. Phentolamine should be administered as soon as possible after extravasation is noted to prevent sloughing/necrosis.
Product contains sodium metabisulfite; use caution in patients with asthma or a sulfite allergy.
Administer infusions into a large vein, particularly an antecubital vein; some clinicians have indicated that the femoral vein is also an acceptable route. Avoid catheter tie-in technique, if possible.
Avoid leg veins in elderly patients or in those suffering from occlusive disorders (eg, atherosclerosis, arteriosclerosis, diabetic endarteritis, Buerger disease).
Gangrene has been reported in a lower extremity when infusions were given in an ankle vein.
Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy.