Levophed (Norepinephrine Bitartrate) - Summary

LEVOPHED SUMMARY

Norepinephrine (sometimes referred to as l-arterenol/Levarterenol or l-norepinephrine) is a sympathomimetic amine which differs from epinephrine by the absence of a methyl group on the nitrogen atom.

Levophed (Norepinephrine) is indicated for the following:

For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions).

As an adjunct in the treatment of cardiac arrest and profound hypotension.

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NEWS HIGHLIGHTS

Media Articles Related to Levophed (Norepinephrine)

Mouse Study Points to Possible Down Syndrome Treatment (CME/CE)
Source: MedPage Today Pediatrics [2009.11.18]
Drugs that stimulate norepinephrine signaling might allow for normal cognitive development in children with Down syndrome, said researchers who tested the hypothesis in mice.

Boosting neurotransmitter could reverse Down Syndrome: study (AFP)
Source: Y! Health Pregnancy News [2009.11.18]
AFP - Boosting a neurotransmitter called norepinephrine in sufferers of Down Syndrome could help reverse the condition, which is the most common cause of mental retardation in children, a study showed Wednesday.

Orthostatic Hypotension
Source: MedicineNet Addison Disease Specialty [2009.06.11]
Title: Orthostatic Hypotension
Category: Diseases and Conditions
Created: 6/11/2009
Last Editorial Review: 6/11/2009

Low Blood Pressure (Hypotension) Photo Slideshow
Source: MedicineNet Addison Disease Specialty [2008.07.30]
Title: Low Blood Pressure (Hypotension) Photo Slideshow
Category: Slideshows
Created: 7/29/2008
Last Editorial Review: 7/30/2008

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Published Studies Related to Levophed (Norepinephrine)

Dopamine versus norepinephrine: is one better? [2009.05]
Dopamine and norepinephrine are widely used as first line agents to correct hypotension in patients with acute circulatory failure. There has been considerable debate in recent years as to whether one is better than the other... Observational studies have provided conflicting results regarding the effects of these two drugs on outcomes, and results from a recently completed randomized controlled trial are eagerly waited.

A comparison of epinephrine and norepinephrine in critically ill patients. [2008.12]
OBJECTIVE: To determine whether there was a difference between epinephrine and norepinephrine in achieving a mean arterial pressure (MAP) goal in intensive care (ICU) patients... CONCLUSIONS: Despite the development of potential drug-related effects with epinephrine, there was no difference in the achievement of a MAP goal between epinephrine and norepinephrine in a heterogenous population of ICU patients.

Estimates of serotonin and norepinephrine transporter inhibition in depressed patients treated with paroxetine or venlafaxine. [2008.12]
Paroxetine and venlafaxine are potent serotonin transporter (SERT) antagonists and weaker norepinephrine transporter (NET) antagonists. However, the relative magnitude of effect at each of these sites during treatment is unknown...

Phenylephrine versus norepinephrine for initial hemodynamic support of patients with septic shock: a randomized, controlled trial. [2008.11.18]
ABSTRACT: INTRODUCTION: Previous findings suggest that a delayed administration of phenylephrine replacing norepinephrine in septic shock patients causes a more pronounced hepatosplanchnic vasoconstriction as compared with norepinephrine. Nevertheless, a direct comparison between the two study drugs has not yet been performed. The aim of the present study was, therefore, to investigate the effects of a first-line therapy with either phenylephrine or norepinephrine on systemic and regional hemodynamics in patients with septic shock... CONCLUSIONS: The present study suggests there are no differences in terms of cardiopulmonary performance, global oxygen transport, and regional hemodynamics when phenylephrine was administered instead of norepinephrine in the initial hemodynamic support of septic shock. TRIAL REGISTRATION: ClinicalTrial.gov NCT00639015.

Norepinephrine activity, as measured by MHPG, is associated with menopausal hot flushes. [2008.10]
OBJECTIVES: Baseline norepinephrine levels, as measured by a metabolite (plasma 3-methoxy-4-hydroxyphenolglycol, MHPG), have been reported to increase in women who experience hot flushes. However, norepinephrine is also discharged in a counter-regulatory attempt to increase brain glucose as normal daily variations occur. The purpose of this analysis is to examine the relationship between hot flush frequency and MHPG under conditions of experimental glucose manipulation... CONCLUSIONS: In this study, there was no consistent pattern of MHPG increase or decrease in the women experiencing hot flushes.

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Clinical Trials Related to Levophed (Norepinephrine)

Norepinephrine Plus Dobutamine Versus Epinephrine Alone for the Management of Septic Shock [Completed]
Catecholamines infusion is a major component of septic shock management. International guidelines recommend that norepinephrine should be preferred to epinephrine, though phase III trials are lacking. The present study aimed at comparing the efficacy and safety of norepinephrine plus dobutamine to that of epinephrine in adults with septic shock.

Dopexamine and Norepinephrine Compared With Epinephrine Alone in Septic Shock [Completed]
In septic shock, when volume resuscitation fails to restore mean arterial pressure, catecholamines such as dopamine, dobutamine, epinephrine, or norepinephrine are used, either alone or in combination. Although they allow hemodynamic success to be obtained, they can leave some regional blood flows impaired, especially the hepatosplanchnic perfusion, which contributes to multiple organ failure.

Dopexamine is a structural and synthetic analog of dopamine that exerts systemic and gut vasodilation and stimulates cardiac contraction. In experimental models, dopexamine has been shown to exert anti-inflammatory properties and to protect the hepatic ultra structure. The combination of dopexamine and norepinephrine could therefore constitute an interesting alternative in treating septic shock patients. This study will test the efficacy (on gastric mucosal blood flow, hepatic damage and oxidative stress) and safety of the combination of dopexamine and norepinephrine (compared to those of epinephrine alone) in the treatment of patients with septic shock.

Dopamine Versus Norepinephrine for the Treatment of Vasopressor Dependent Septic Shock [Recruiting]
We are performing a prospective, randomized, controlled trial of dopamine versus norepinephrine for septic shock. The trial will enroll patients with suspected or documented site of infection and having 2 out of the three SIRS criteria. Patients will also be receiving standard of care, early-goal directed therapy including but not limited to fluid resuscitation, appropriate and early antibiotics, source control and evaluation for drotrecogin alpha where deemed appropriate, while being supported for septic shock.

Pharmacogenetic Study of Methylphenidate in Attention Deficit/Hyperactivity Disorder(ADHD) [Recruiting]
The noradrenergic system plays a known role in attentional systems and suspected causal role in attention deficit/hyperactivity disorder(ADHD).Methylphenidate also has been suspected as a inhibitor of norepinephrine transporter(SLC6A2). The investigators hypothesis is that norepinephrine transporter polymorphism is associated with responses and adverse effects of OROS-methylphenidate in treatment of ADHD.

Phenylephrine in Septic Shock [Recruiting]
The present study was conducted as a prospective, randomized, controlled study to compare: A) the effects of norepinephrine and phenylephrine on systemic and regional hemodynamics in patients with catecholamine-dependent septic shock. B)to test the hypothesis that norepinephrine may likewise better preserve hepatosplanchnic perfusion versus phenylephrine in patients suffering from septic shock.

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