PITHWIT

Noradrenaline (norepinephrine) is a neurotransmitter and hormone produced in the adrenal glands and sympathetic nerve endings. It plays a vital role in the body’s “fight or flight” response to stress. As a neurotransmitter, it regulates brain functions like arousal, attention, and mood. As a hormone, it increases heart rate and blood pressure by acting on the heart and blood vessels. Produced from dopamine, noradrenaline helps control mood, alertness, and blood pressure, playing a key role in both the central and autonomic nervous systems.

Mechanism of Action

Noradrenaline works by

Stimulating alpha-adrenergic receptors

Causes vasoconstriction, which increases blood pressure.

Stimulating beta-adrenergic receptors (to a lesser extent)

Increases heart rate and myocardial contractility, improving cardiac output.

Doses and Administration

Route: Intravenous (IV) infusion only.

Dilution: Must be diluted in 5% dextrose or saline before administration.

Initial Dose:

0.01–0.03 µg/kg/min.

Maintenance Dose:

Titrated up to 0.1–1 µg/kg/min based on clinical response.

Monitoring: Requires continuous blood pressure, heart rate, and perfusion monitoring during administration.

Indications

Severe Hypotension: When unresponsive to fluid resuscitation.

Septic Shock: First-line vasopressor.

Cardiogenic Shock: To restore adequate perfusion in impaired cardiac function.

Other Shock States: Neurogenic or anaphylactic shock, as adjunctive therapy.