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Levophed
Overview
What is Levophed?
Norepinephrine (sometimes referred to as or ) is a sympathomimetic amine which differs from epinephrine by the absence of a methyl group on the nitrogen atom.
Norepinephrine Bitartrate is (-)-α-(aminomethyl)-3,4-dihydroxybenzyl alcohol tartrate (1:1) (salt) monohydrate and has the following structural formula:
LEVOPHED is supplied in sterile aqueous solution in the form of the bitartrate salt to be administered by intravenous infusion following dilution. Norepinephrine is sparingly soluble in water, very slightly soluble in alcohol and ether, and readily soluble in acids. Each mL contains the equivalent of 1 mg base of norepinephrine, sodium chloride for isotonicity, and not more than 2 mg of sodium metabisulfite as an antioxidant. It has a pH of 3 to 4.5. The air in the ampuls has been displaced by nitrogen gas.
What does Levophed look like?
What are the available doses of Levophed?
Sorry No records found.
What should I talk to my health care provider before I take Levophed?
Sorry No records found
How should I use Levophed?
For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions).
As an adjunct in the treatment of cardiac arrest and profound hypotension.
Norepinephrine Bitartrate Injection is a concentrated, potent drug which must be diluted in dextrose containing solutions prior to infusion. An infusion of LEVOPHED should be given into a large vein (see ).
Restoration of Blood Pressure in Acute Hypotensive States
Blood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, LEVOPHED can be administered before and concurrently with blood volume replacement.
Average Dosage:
High Dosage:
Fluid Intake:
Duration of Therapy:
Adjunctive Treatment in Cardiac Arrest
Infusions of LEVOPHED are usually administered intravenously during cardiac resuscitation to restore and maintain an adequate blood pressure after an effective heartbeat and ventilation have been established by other means. [LEVOPHED’s powerful beta-adrenergic stimulating action is also thought to increase the strength and effectiveness of systolic contractions once they occur.]
Average Dosage:
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to use, whenever solution and container permit.
Do not use the solution if its color is pinkish or darker than slightly yellow or if it contains a precipitate.
Avoid contact with iron salts, alkalis, or oxidizing agents.
What interacts with Levophed?
LEVOPHED should not be given to patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed. If LEVOPHED is continuously administered to maintain blood pressure in the absence of blood volume replacement, the following may occur: severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis.
LEVOPHED should also not be given to patients with mesenteric or peripheral vascular thrombosis (because of the risk of increasing ischemia and extending the area of infarction) unless, in the opinion of the attending physician, the administration of LEVOPHED is necessary as a life-saving procedure.
Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and therefore seem to sensitize the myocardium to the action of intravenously administered epinephrine or norepinephrine. Hence, the use of LEVOPHED during cyclopropane and halothane anesthesia is generally considered contraindicated because of the risk of producing ventricular tachycardia or fibrillation.
The same type of cardiac arrhythmias may result from the use of LEVOPHED in patients with profound hypoxia or hypercarbia.
What are the warnings of Levophed?
Cyclobenzaprine hydrochloride may enhance the effects of alcohol, barbiturates, and other CNS depressants.
LEVOPHED 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.
LEVOPHED Bitartrate Injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people.
What are the precautions of Levophed?
The rate of flow must be watched constantly, and the patient should never be left unattended while receiving LEVOPHED. Headache may be a symptom of hypertension due to overdosage.
Site of Infusion:
This also may progress on rare occasions to superficial slough, particularly during infusion into leg veins in elderly patients or in those suffering from obliterative vascular disease. Hence, if blanching occurs, consideration should be given to the advisability of changing the infusion site at intervals to allow the effects of local vasoconstriction to subside.
What are the side effects of Levophed?
The following reactions can occur:
Prolonged administration of any potent vasopressor may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy. If plasma volumes are not corrected, hypotension may recur when LEVOPHED is discontinued, or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g., decreased renal perfusion) with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury. Gangrene of extremities has been rarely reported.
Overdoses or conventional doses in hypersensitive persons (e.g., hyperthyroid patients) cause severe hypertension with violent headache, photophobia, stabbing retrosternal pain, pallor, intense sweating, and vomiting.
What should I look out for while using Levophed?
LEVOPHED should not be given to patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed. If LEVOPHED is continuously administered to maintain blood pressure in the absence of blood volume replacement, the following may occur: severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis.
LEVOPHED should also not be given to patients with mesenteric or peripheral vascular thrombosis (because of the risk of increasing ischemia and extending the area of infarction) unless, in the opinion of the attending physician, the administration of LEVOPHED is necessary as a life-saving procedure.
Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and therefore seem to sensitize the myocardium to the action of intravenously administered epinephrine or norepinephrine. Hence, the use of LEVOPHED during cyclopropane and halothane anesthesia is generally considered contraindicated because of the risk of producing ventricular tachycardia or fibrillation.
The same type of cardiac arrhythmias may result from the use of LEVOPHED in patients with profound hypoxia or hypercarbia.
LEVOPHED 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.
LEVOPHED Bitartrate Injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people.
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What might happen if I take too much Levophed?
Overdosage with LEVOPHED may result in headache, severe hypertension, reflex bradycardia, marked increase in peripheral resistance, and decreased cardiac output. In case of accidental overdosage, as evidenced by excessive blood pressure elevation, discontinue LEVOPHED until the condition of the patient stabilizes.
How should I store and handle Levophed?
Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].Preserve in tight, light-resistant containers as defined in the USP.Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].Preserve in tight, light-resistant containers as defined in the USP.LEVOPHED, norepinephrine bitartrate injection, USP, contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL). Supplied as:Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Protect from light.Regitine, trademark, CIBA Pharmaceuticals Company.Distributed by Hospira, Inc., Lake Forest, IL 60045, USANOVAPLUS is a registered trademark of Vizient, Inc.LAB-0891-2.0Revised: 03/2018LEVOPHED, norepinephrine bitartrate injection, USP, contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL). Supplied as:Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Protect from light.Regitine, trademark, CIBA Pharmaceuticals Company.Distributed by Hospira, Inc., Lake Forest, IL 60045, USANOVAPLUS is a registered trademark of Vizient, Inc.LAB-0891-2.0Revised: 03/2018LEVOPHED, norepinephrine bitartrate injection, USP, contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL). Supplied as:Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Protect from light.Regitine, trademark, CIBA Pharmaceuticals Company.Distributed by Hospira, Inc., Lake Forest, IL 60045, USANOVAPLUS is a registered trademark of Vizient, Inc.LAB-0891-2.0Revised: 03/2018LEVOPHED, norepinephrine bitartrate injection, USP, contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL). Supplied as:Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Protect from light.Regitine, trademark, CIBA Pharmaceuticals Company.Distributed by Hospira, Inc., Lake Forest, IL 60045, USANOVAPLUS is a registered trademark of Vizient, Inc.LAB-0891-2.0Revised: 03/2018LEVOPHED, norepinephrine bitartrate injection, USP, contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL). Supplied as:Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Protect from light.Regitine, trademark, CIBA Pharmaceuticals Company.Distributed by Hospira, Inc., Lake Forest, IL 60045, USANOVAPLUS is a registered trademark of Vizient, Inc.LAB-0891-2.0Revised: 03/2018LEVOPHED, norepinephrine bitartrate injection, USP, contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL). Supplied as:Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Protect from light.Regitine, trademark, CIBA Pharmaceuticals Company.Distributed by Hospira, Inc., Lake Forest, IL 60045, USANOVAPLUS is a registered trademark of Vizient, Inc.LAB-0891-2.0Revised: 03/2018LEVOPHED, norepinephrine bitartrate injection, USP, contains the equivalent of 4 mg base of LEVOPHED per each 4 mL ampul (1 mg/mL). Supplied as:Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.] Protect from light.Regitine, trademark, CIBA Pharmaceuticals Company.Distributed by Hospira, Inc., Lake Forest, IL 60045, USANOVAPLUS is a registered trademark of Vizient, Inc.LAB-0891-2.0Revised: 03/2018
Clinical Information
Chemical Structure
No Image foundClinical Pharmacology
LEVOPHED functions as a peripheral vasoconstrictor (alpha-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries (beta-adrenergic action).
Non-Clinical Toxicology
LEVOPHED should not be given to patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed. If LEVOPHED is continuously administered to maintain blood pressure in the absence of blood volume replacement, the following may occur: severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis.LEVOPHED should also not be given to patients with mesenteric or peripheral vascular thrombosis (because of the risk of increasing ischemia and extending the area of infarction) unless, in the opinion of the attending physician, the administration of LEVOPHED is necessary as a life-saving procedure.
Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and therefore seem to sensitize the myocardium to the action of intravenously administered epinephrine or norepinephrine. Hence, the use of LEVOPHED during cyclopropane and halothane anesthesia is generally considered contraindicated because of the risk of producing ventricular tachycardia or fibrillation.
The same type of cardiac arrhythmias may result from the use of LEVOPHED in patients with profound hypoxia or hypercarbia.
LEVOPHED 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.
LEVOPHED Bitartrate Injection contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people.
Cyclobenzaprine may have life-threatening interactions with MAO inhibitors (see ). Postmarketing cases of serotonin syndrome have been reported during combined use of cyclobenzaprine hydrochloride and other drugs, such as SSRIs, SNRIs, TCAs, tramadol, bupropion, meperidine, verapamil, or MAO inhibitors. If concomitant treatment with cyclobenzaprine hydrochloride and other serotonergic drugs is clinically warranted, careful observation is advised, particularly during treatment initiation or dose increases (see ).
Cyclobenzaprine hydrochloride may enhance the effects of alcohol, barbiturates, and other CNS depressants.
Tricyclic antidepressants may block the antihypertensive action of guanethidine and similarly acting compounds.
Tricyclic antidepressants may enhance the seizure risk in patients taking tramadol.
Array
The rate of flow must be watched constantly, and the patient should never be left unattended while receiving LEVOPHED. Headache may be a symptom of hypertension due to overdosage.
Site of Infusion:
This also may progress on rare occasions to superficial slough, particularly during infusion into leg veins in elderly patients or in those suffering from obliterative vascular disease. Hence, if blanching occurs, consideration should be given to the advisability of changing the infusion site at intervals to allow the effects of local vasoconstriction to subside.
The following reactions can occur:
Prolonged administration of any potent vasopressor may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy. If plasma volumes are not corrected, hypotension may recur when LEVOPHED is discontinued, or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g., decreased renal perfusion) with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury. Gangrene of extremities has been rarely reported.
Overdoses or conventional doses in hypersensitive persons (e.g., hyperthyroid patients) cause severe hypertension with violent headache, photophobia, stabbing retrosternal pain, pallor, intense sweating, and vomiting.
Reference
This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"
While we update our database periodically, we cannot guarantee it is always updated to the latest version.
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