Noradrenaline is the first-line medicine in septic shock and very low blood pressures in intensive care: it constricts vessels to restore blood pressure while keeping the heart working.
Also known as: Norepinefrina, Levophed
Methylergometrine plus noradrenaline adds intense α-adrenergic vasoconstriction, with risk of limb, myocardial and gut ischaemia and hypertensive crisis.
Noradrenaline is a potent α1 agonist (systemic vasoconstriction); ergot alkaloids add their own vasoconstriction (serotonergic/α) — the combination is proarrhythmic and ischaemic (EMC Ergometrine: contraindicated in occlusive vascular disease).
Invasive BP, peripheral perfusion (capillary refill), lactate, ECG.
Cold/mottled extremities, chest pain, ischaemic abdominal pain.
Avoid co-administration; in postpartum haemorrhagic/septic shock, prefer oxytocin; if use is unavoidable, invasive BP and distal perfusion monitoring.
EMC-UK — Ergometrine Injection BP 0.05% w/v (hameln pharma), SmPC 4.3 (occlusive vascular disease contraindicated) and 4.4 (vasoconstriction): https://www.medicines.org.uk/emc/product/6265/smpc
No documented food or drink interactions.
Noradrenaline is a direct vasoconstrictor — hypertensive crisis in phaeochromocytoma.
Contraindicated; alternative: vasopressor of choice in septic shock.
Site monograph (noradrenaline — severe extravasation, phentolamine available).
Noradrenaline raises afterload — in low-output HF may worsen (add inotrope).
At dose > 1 mcg/kg/min, reassess diagnosis and add inotrope if needed (site monograph).
Site monograph (noradrenaline — add inotrope if needed).
No specific Annex 1 entry; noradrenaline is the first-line vasopressor in maternal septic shock (better maternal survival than dopamine). At high doses it causes placental vasoconstriction — but in maternal shock, restoring maternal perfusion pressure is the priority to save the fetus. ICU use with continuous monitoring.
Emergency use in maternal shock (ICU), first line; lowest effective dose; continuous maternal and fetal monitoring.
Compatible as an emergency drug (minutes half-life).
Surviving Sepsis Campaign (noradrenaline as first-line vasopressor, including in pregnancy). EMC-UK (MHRA) — Noradrenaline SmPC.
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Intense systemic vasoconstriction with moderate inotropy; ↑ systolic and diastolic blood pressure.
Predominant α1 agonist (vasoconstriction) with moderate β1 (inotropy) and minimal β2 (no bronchodilation).
IV exclusive (continuous infusion); does not significantly cross the blood-brain barrier.
Metabolised by MAO and COMT (half-life < 2 min); renal excretion of metabolites (VMA, normetanephrine).
~ 2 min (IV).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
