Norepinephrine Agetan, concentrate 2 mg/ml 8 ml 10 pcs

Noradrenaline Agetan is an adrenomimetic.

Pharmacodynamics

An agonist of α_l– and α₂-adrenergic receptors. It weakly excites β₁– and has virtually no effect on β₂-adrenoreceptors. It has a powerful vasoconstrictor effect and leads to elevation.

Pharmacokinetics

It is not absorbed in the gastrointestinal tract. It quickly reaches C_max in plasma (within 2-3 min) when administered intravenously.

It is metabolized in the liver, kidneys and blood plasma with the participation of MAOI and catechol-O-methyltransferase (COMT) to nearly inactive metabolites, which are excreted through the kidneys.

Indications

Acute hypotension accompanying cardiovascular collapse and shock (IV perfusion to restore and maintain BP).

Active ingredient

Norepinephrine

Composition

Active substances:

norepinephrine tartrate monohydrate;

Associates:

sodium chloride;

Sodium hydroxide or hydrochloric acid (pH = 3.0-4.5);

Injectable water

How to take, the dosage

Intravenously, preferably in the ulnar flexure vein.

The concentrate should be diluted in 5% glucose solution or 0.9% sodium chloride solution. Do not mix with other drugs. When administering Norepinephrine Agetan, BP and HR should be constantly monitored.

After dilution of the concentrate, the solution should be used within 12 hours.

The individual dose is established depending on the clinical condition of the patient. A starting dose and infusion rate of 0.1 to 0.3 μg/kg/min of noradrenaline tartrate is recommended. The maximum dose and rate of administration used in the treatment of septic and hemorrhagic shock can reach 3-5 μg/kg/min.

Interaction

The main undesirable effects when combined with some groups of drugs are pharmacodynamic.

When combined with inhaled anesthetics, serious ventricular arrhythmias (increased excitability of the heart) may occur.

When combined with serotonergic and adrenergic antidepressants, as well as imipramine and amitriptyline derivatives, paroxysmal hypertension may develop with a risk of cardiac arrhythmias due to the adrenoblocking effect on the sympathetic nervous system.

The combination of Norepinephrine Agetan with selective and non-selective MAOI inhibitors, linezolid is contraindicated because it synergistically enhances the pressor effect of norepinephrine, which requires close medical monitoring.

Contraindications

• expressed hypersensitivity to the drug;
• arterial hypotension due to hypovolemia. An exception in these cases is the need to administer the drug to maintain blood flow in the coronary arteries of the heart and brain arteries until the end of therapy aimed at restoring the blood circulation;
• Performance of fluorotane and cyclopropane general anesthesia (due to risk of ventricular tachycardia and fibrillation);
• expressive hypoxia and hypercapnia.

With caution:

• expressed left ventricular failure, acute heart failure, recent myocardial infarction;
• concomitant use of imipramine-type and tryptiline-type MAO inhibitors (due to the risk of significant and prolonged rise in BP);
• development of cardiac arrhythmia symptoms (in this case, reduction of the drug dose is necessary). In case of polymorphic extrasystoles or development of volleys of extrasystoles, the drug dose should be significantly reduced or the treatment should be cancelled.

.

Side effects

The following symptoms may occur during administration of Norepinephrine Agetan:

• ischemic disturbances up to and including necrosis caused by vasoconstriction and tissue hypoxia, and due to extravasation;
• arrhythmia;
• reflexive bradycardia;
• anxiety;
• breathing difficulties;
• tremor;
• transient headache;
• chest or pharyngeal pain;
• vegetative reactions – pallor, increased sweating, vomiting, tachycardia. In especially sensitive patients, increased BP may be accompanied by headache, photophobia, prickly chest pain, pale skin, increased sweating, and vomiting.

In long-term use, dose adjustment is necessary to avoid relapse of hypotension when discontinuing the drug.

Overdose

Symptoms: skin vasospasm, collapse, anuria, marked increase in BP may be observed.

Treatment: In case of overdose the drug dose should be reduced.

Pregnancy use

Pregnancy is not a restriction for the use of Norepinephrine Agetan. Breastfeeding should be stopped during the treatment (there is no experience of using the drug in breastfeeding women).