Levophed SF Dosage/Direction for Use

Posology: Adults: Initial rate of infusion: When diluted as recommended in Special Precautions for Disposal and Other Handling under Cautions for Usage (the concentration of the prepared infusion is 40 mg/liter noradrenaline base (80 mg/liter noradrenaline tartrate)) the initial rate of infusion, at a body weight of 70 kg, should be between 10 mL/hour and 20 mL/hour (0.16 to 0.33 mL/min). This is equivalent to 0.4 mg/hour to 0.8 mg/hour noradrenaline base (0.8 mg/hour to 1.6 mg/hour noradrenaline tartrate). Some clinicians may wish to start at a lower initial infusion rate of 5 mL/hour (0.08 mL/min), equivalent to 0.2 mg/hour noradrenaline base (0.4 mg/hour noradrenaline tartrate).
Titration of dose: Once an infusion of noradrenaline has been established, the dose should be titrated in steps of 0.05-0.1 μg/kg/min of noradrenaline base according to the pressor effect observed. 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 - 80 mm Hg - depending on the patient's condition). (See Table 1.)

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Some clinicians may prefer to dilute to other concentrations. If dilutions other than 40 mg/L are used, check the infusion rate calculation carefully before starting treatment.
Renal or hepatic impairment: There is no experience in treatment of renally or hepatically impaired patients.
Elderly: As for adults but see Precautions.
Pediatric population: Not recommended.
Duration of Treatment and Monitoring: Noradrenaline should be continued for as long as vasoactive drug support is indicated. The patient should be monitored carefully for the duration of therapy. Blood pressure should be carefully monitored for the duration of therapy.
Withdrawal of Therapy: The noradrenaline infusion should be gradually decreased since abrupt withdrawal can result in acute hypotension.
Route of Administration: For intravenous use.
Method of Administration: Administer as a diluted solution via a central venous catheter.
The infusion should be at a controlled rate using either a syringe pump or an infusion pump or a drip counter.
For instructions on dilution of the medicinal product before administration, see Special Precautions for Disposal and Other Handling under Cautions for Usage.