Levophed Injection: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Levophed Injection (norepinephrine bitartrate) is a catecholamine vasopressor given as a continuous infusion into a vein in hospital settings to raise dangerously low blood pressure. It is used in adults for severe acute hypotension, including after certain surgeries, severe infections, transfusion or drug reactions, heart attack, and during cardiac arrest alongside CPR. It works by narrowing blood vessels and strengthening heart contractions to restore blood flow to vital organs. Treatment is closely monitored and dosed according to blood pressure response.

What is Levophed Injection

Levophed is a medicine similar to adrenaline that is given as an infusion into a vein in hospital settings to raise dangerously low blood pressure. Its generic name is norepinephrine bitartrate, and it belongs to the catecholamine/vasopressor drug class.

Levophed Injection uses

• Treats severe, acute low blood pressure in adults
• Used for blood pressure control in certain acute low blood pressure conditions, such as after certain surgeries, severe infections, blood transfusion reactions, drug reactions, or heart attack
• Used as an additional treatment during cardiac arrest and profound low blood pressure, often during CPR

Benefits of Levophed Injection

• Raises blood pressure quickly to help maintain blood flow to vital organs
• Increases the strength of heart contractions, which can help during cardiac resuscitation
• Raises dangerously low blood pressure
• Helps restore blood flow to vital organs
• Produces rapid vasoconstriction
• Commonly used for severe acute hypotension and shock
• Allows continuous dose adjustment according to blood-pressure response

How Levophed Injection works

Levophed narrows blood vessels and makes the heart pump more strongly, which raises blood pressure and improves blood flow to important organs.

Levophed Injection dosage

Levophed is given only by a healthcare provider as a continuous infusion into a large vein, and it is never injected directly without dilution. It must be diluted in a dextrose-containing solution before use and should not be given in saline solution alone. The infusion rate is adjusted based on blood pressure response, and blood pressure is checked often during treatment. It should not be given into leg veins in elderly patients or those with blood vessel disease. When stopping treatment, the infusion rate is reduced gradually rather than stopped suddenly, to avoid a sudden drop in blood pressure. Treatment may continue for several days until the body responds and blood pressure stabilizes without it. Caregivers should be told right away about any pain, burning, irritation, or discoloration at the injection site.

Available forms and strengths

• Injection (solution) in single-dose glass vials
• Injection (solution) in single-dose glass ampules

Side effects of Levophed Injection

Common

• Anxiety
• Transient headache
• Breathing difficulty
• Slow heart rate (bradycardia)

Serious

• Tissue damage (necrosis) and sloughing if the medicine leaks out of the vein
• Irregular heart rhythms (arrhythmias)
• Allergic reactions, including severe or life-threatening asthma-type reactions, due to a sulfite ingredient
• Little or no urination
• Blue lips or fingernails, mottled skin
• Sudden numbness, weakness, or cold feeling anywhere in the body
• Problems with vision, speech, or balance
• Severe headache, blurred vision, or pounding in the neck or ears
• Gangrene of the extremities in patients with blood vessel disease or after prolonged or high-dose infusions

Warnings and precautions

• Avoid letting the medicine leak out of the vein into surrounding tissue, since this can cause tissue death; it should be given into a large vein and the injection site checked often.
• Stopping the infusion suddenly can cause a sharp drop in blood pressure; the rate should be reduced gradually instead.
• This medicine may cause abnormal heart rhythms, so heart function should be monitored, especially in people with existing heart disease.
• This medicine contains a sulfite preservative that can cause allergic reactions, including severe asthma-like attacks, in sensitive people.
• Combining this medicine with certain antidepressants or MAO inhibitor drugs can cause severe, prolonged high blood pressure.
• Using this medicine with certain anesthesia gases can cause dangerous fast or irregular heartbeats.
• This medicine can lower the body's sensitivity to insulin and raise blood sugar, so glucose levels should be monitored in people with diabetes.
• Levophed should only be given to a pregnant woman if clearly needed; limited data have not shown an increased risk of major birth defects or miscarriage, but life-saving treatment for the mother should not be withheld over concerns about effects on the baby.
• It is not known if this medicine passes into breast milk, but significant exposure to a breastfed infant is not expected because the drug does not stay in the body long and is poorly absorbed by mouth.
• Kidney perfusion and function require close monitoring during shock and vasopressor therapy.
• Elderly patients with reduced liver function may need a more cautious, lower starting dose.
• Not appropriate during an acute critical illness requiring norepinephrine when combined with alcohol.
• Not applicable to driving; Levophed is administered in a monitored medical setting.

Storage

• Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F)
• Store in original carton until time of administration to protect from light
• Discard unused portion
• Do not use the solution if its color is pinkish or darker than slightly yellow or if it contains a precipitate

When to see a doctor

• Get emergency help right away for signs of an allergic reaction, such as hives, difficulty breathing, or swelling of the face, lips, tongue, or throat.
• Tell caregivers immediately about pain, burning, irritation, discoloration, or skin changes where the injection was given.
• Report sudden numbness, weakness, or a cold feeling anywhere in the body right away.
• Seek help immediately for a slow or uneven heartbeat.
• Report blue lips or fingernails or blotchy skin right away.
• Tell caregivers immediately if there is little or no urination.
• Seek help right away for trouble breathing.
• Report any problems with vision, speech, or balance right away.
• Seek help immediately for a severe headache, blurred vision, or pounding feeling in the neck or ears, which can be signs of dangerously high blood pressure.

Alternatives

• Epinephrine
• Phenylephrine
• Vasopressin