Norfine Dosage/Direction for Use

Posology: Adults: Add 2 mL of Norepinephrine 1 mg/mL concentrate for solution for infusion to 48 mL 50 mg/mL (5%) glucose (or other solutions for dilution mentioned in Special precautions for disposal and other handling under Cautions for Usage) for administration by syringe pump. The final concentration of the infusion solution is 80 mg/litre Norepinephrine, which is equivalent to 40 mg/litre Norepinephrine. If other dilutions are used check the calculation carefully before starting treatment.
Initial Rate of Infusion: The initial rate of infusion should be between 10 mL/hour and 20 mL/hour (0.16 mL/min to 0.32 mL/min). This is equivalent to 0.8 mg/hour to 1.6 mg/hour Norepinephrine (or 0.4 mg/hour to 0.8 mg/hour Norepinephrine).
Titration of Dose: Once an infusion of Norepinephrine has been established the dose should be titrated 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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Duration of Treatment and Monitoring: Norepinephrine should be continued until adequate blood pressure and tissue perfusion are maintained without therapy. The patient should be monitored carefully for the duration of Norepinephrine therapy.
Norepinephrine should only be administered by healthcare professionals who are familiar with its use and have appropriate facilities to adequately monitor the patient.
Withdrawal of Therapy: Infusions should be reduced gradually, avoiding abrupt withdrawal which can result in acute hypotension.
Hepatic/Renal Impairment: There is no experience in treatment of hepatically or renally impaired patients.
Elderly: In general, dose selection for an elderly patient should be cautious, starting at the low end of the dosing range as to reflect the greater frequency of decreased hepatic, renal or cardiac function and concomitant disease or other drug therapy.
Paediatric Population: The safety and efficacy of Norepinephrine in children less than 18 years of age has not yet been established. No data are available.
Method of Administration: Route of Administration: Intravenous use after dilution.
Norepinephrine 1 mg/mL concentrate for solution for infusion should be diluted and should be administered 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.