FDA-filed SPL labeling · retrieved through openFDA

Norepinephrine

Norepinephrine is an emergency medicine given intravenously to rapidly raise dangerously low blood pressure in adults with severe, acute hypotension.

Brand names LevophedNorepinephrine Bitartrate In Sodium ChlorideNorepinephrine Phenolic
Drug class Catecholamines
Rx/OTC Forms 2 Routes Intravenous · Oral
Dr. Brian Staiger, PharmD, BCPS
Reviewed by Last reviewed Jul 10, 2026
🧬 Where this information comes from Click to expand

The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 30 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →

At a glance
Linked label effectiveFeb 6, 2026
Clinical labels in scope 30
AvailabilityRx/OTC
Earliest approval/marketing year 1950
FDA-listed product records 91
Boxed warningNone found in compared labels
How we combine label and product data →
No current FDA shortage listed · checked Sep 20, 2026 🚨Recall on record
Norepinephrine at a glance The quick version — the full detail is in the Patient Information Guide below.
💊
HelloPharmacist Editorial Team Bottom Line
Norepinephrine is a fast-acting, hospital-only emergency medicine used to restore dangerously low blood pressure in critically ill adults. It works quickly but requires careful monitoring of blood pressure, heart rhythm, and the IV site throughout the infusion. Because it is managed entirely by a medical team, patients and families should focus on communicating any known allergies, current medications, and medical history to the care team as quickly as possible.

📖 Norepinephrine: Patient Information Guide

A plain-language walkthrough of Norepinephrine — what it treats, how it works, how it’s taken, side effects, warnings and interactions. Tap any section to expand it.

🎯What it's used for

Norepinephrine injection is used in emergency and critical care settings to rapidly restore blood pressure. Specific approved uses vary by product:

  • Levophed (intravenous injection) is indicated to raise blood pressure in adult patients with severe, acute hypotension
  • Norepinephrine Bitartrate injection products (intravenous) are indicated to restore blood pressure in adult patients with acute hypotensive states
  • Norepinephrine Bitartrate concentrate (intravenous) is used for blood pressure control in conditions including septicemia (serious bloodstream infection), heart attack, spinal anesthesia complications, blood transfusion reactions, and drug reactions — and as an adjunct treatment during cardiac arrest and profound hypotension
  • Norepinephrine Bitartrate In Sodium Chloride injection is indicated to raise blood pressure in adult patients with severe, acute hypotension
  • Norepinephrine in Sodium Chloride injection is indicated to raise blood pressure in adult patients with severe, acute hypotension
⚙️How it works

Norepinephrine works through two types of receptor actions in the body. Its alpha-adrenergic action causes blood vessels throughout the body to constrict (narrow), which raises blood pressure and increases resistance in the circulatory system. Its beta-adrenergic action stimulates the heart to pump more forcefully and widens the coronary arteries — the vessels feeding the heart itself — helping to maintain cardiac function under stress.

The net result is a rapid rise in blood pressure. Heart rate often slows slightly as a reflex response to the higher pressure, while stroke volume (the amount of blood pumped per beat) tends to increase. Blood flow to the skin, skeletal muscles, and abdominal organs may decrease as vessels constrict, but coronary blood flow actually increases.

💊How it's taken

Norepinephrine is given only by continuous intravenous infusion in a hospital or critical care setting — never taken by mouth or self-administered. The rate of infusion is adjusted by the medical team based on real-time blood pressure readings until a target pressure is reached, then maintained at the lowest effective rate.

  • Some formulations (such as Norepinephrine Bitartrate concentrate) must be diluted before use; others (such as Norepinephrine Bitartrate In Sodium Chloride and Norepinephrine in Sodium Chloride) are ready to use without further dilution
  • The infusion is always tapered gradually when stopping — abrupt discontinuation can cause a dangerous drop in blood pressure
  • Low blood volume must be corrected before or alongside the infusion
🤒Side effects — in detail

The most common side effects of norepinephrine include:

  • High blood pressure (hypertension)
  • Slow heart rate (bradycardia)
  • Anxiety
  • Headache
  • Difficulty breathing
  • Fluid buildup in the lungs (pulmonary edema)
  • Skin and tissue damage at or around the IV site (extravasation necrosis)

More serious reactions — including dangerous heart rhythms, severe allergic reactions (including anaphylaxis in sulfite-sensitive patients), and tissue ischemia (injury from blocked blood flow) — require immediate medical attention and are managed by the clinical team on-site.

⚠️Warnings & precautions
  • Tissue ischemia and IV site injury: If norepinephrine leaks from the vein into surrounding tissue (extravasation), it can cause severe tissue damage or death (necrosis). The infusion site must be monitored continuously and given only into large veins. Emergency treatment with phentolamine is required if leakage is suspected.
  • Abrupt discontinuation: Stopping the infusion suddenly can cause a sharp drop in blood pressure. The rate must always be reduced gradually.
  • Heart rhythm problems: Norepinephrine can cause arrhythmias (irregular heartbeats), particularly in patients with underlying heart disease or low oxygen levels. Continuous heart monitoring is required.
  • Sulfite allergy risk: Some formulations contain sodium metabisulfite, which can trigger severe allergic reactions — including anaphylaxis and serious asthma attacks — in susceptible individuals, particularly those with asthma.
  • Vascular disease: Patients with blocked or clotted blood vessels face a higher risk of worsening ischemia (tissue injury) and should not receive norepinephrine if safer alternatives exist.
🔀What it interacts with

Norepinephrine can interact dangerously with several medications. The medical team should know about all drugs the patient is taking:

  • MAO inhibitors (including linezolid) — can cause severe, prolonged high blood pressure; close monitoring is required if these drugs were recently used
  • Tricyclic antidepressants (including amitriptyline, imipramine, nortriptyline, clomipramine, desipramine, protriptyline) — can also cause severe, prolonged high blood pressure
  • Antidiabetic medicines — norepinephrine can raise blood sugar and reduce insulin sensitivity; blood glucose monitoring and possible dose adjustments are needed
  • Halogenated anesthetics (including cyclopropane, isoflurane, desflurane, enflurane, sevoflurane) — increase the risk of serious heart rhythm problems (ventricular tachycardia or ventricular fibrillation); heart rhythm must be monitored continuously

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

📋Before taking it
  • Any history of sulfite or bisulfite allergy, or asthma — some formulations contain sodium metabisulfite and can trigger serious allergic reactions
  • Low blood volume (hypovolemia) must be identified and treated before or alongside norepinephrine therapy
  • Blocked, clotted, or diseased blood vessels (mesenteric or peripheral vascular thrombosis, occlusive vascular disease) — norepinephrine may worsen ischemia in these conditions
  • Current use of MAO inhibitors or tricyclic antidepressants — these combinations can cause dangerously high blood pressure
  • Underlying heart disease or arrhythmias — requires extra cardiac monitoring
  • Pregnancy: Limited data suggest norepinephrine is used when the risk of untreated severe hypotension to mother and baby outweighs the risk of treatment. Life-saving therapy should not be withheld.
  • Breastfeeding: No data exist on norepinephrine in breast milk; meaningful infant exposure is not expected given how quickly the drug is cleared from the body
  • Children: Safety and effectiveness in pediatric patients have not been established
  • Older adults: Elderly patients may be more sensitive to adverse effects; leg vein infusion should be avoided; dosing starts at the lower end of the range
🚑If you take too much

Too much norepinephrine can cause a severe spike in blood pressure, a reflex drop in heart rate (bradycardia), intense headache, greatly increased resistance in the blood vessels, and reduced output from the heart. If overdose occurs, the infusion is stopped until the patient's condition stabilizes.

📡Pharmacodynamics — effects in the body

Norepinephrine's primary effects are stimulating the heart and constricting blood vessels. Blood pressure rises quickly as vascular resistance increases, and the body often responds with a reflex slowing of the heart rate and an increase in stroke volume (the amount of blood the heart pumps with each beat). While coronary blood flow increases significantly, blood flow to the abdominal organs and skeletal muscles decreases. After intravenous infusion begins, the blood pressure response reaches a steady level within about 5 minutes, and the effect stops within 1 to 2 minutes after the infusion is turned off.

🔬Pharmacokinetics — how your body processes it

When given intravenously, norepinephrine reaches a steady level in the blood within about 5 minutes. It has a very short half-life of roughly 2.4 minutes — meaning the body clears it extremely fast. Norepinephrine is broken down mainly in the liver and other tissues by enzymes (COMT and MAO) into inactive byproducts, which are then excreted in the urine. It does not cross the blood-brain barrier, but it does cross the placenta. Only a tiny amount is excreted from the body unchanged.

📦How to store it

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.

📄 Written from Norepinephrine’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Every point is grounded in that labeling — nothing is invented. How we use AI →

🩺 Pharmacist Counseling Corner

Quick, plain-English answers to the questions patients ask most about Norepinephrine — the kind of thing our pharmacy team would talk through with you at the counter.

Why is my loved one receiving norepinephrine in the ICU?
Norepinephrine is used when someone's blood pressure drops to a dangerously low level — low enough to put the brain, heart, and other organs at risk. It works very quickly to bring blood pressure back up to a safer range. It's one of the most commonly used medicines in critical care for this purpose, and it's given continuously through an IV so the team can adjust the dose in real time based on how the patient responds.
Can norepinephrine cause any serious problems I should watch for?
The medical team will be watching closely for a few important things. The biggest concern is that if the IV leaks, norepinephrine can damage the tissue around the site — so any pain, swelling, or color change near the IV line should be flagged immediately. It can also cause the heart rate to slow or trigger irregular heart rhythms, so continuous heart monitoring is standard. Stopping the infusion too quickly can also cause blood pressure to drop suddenly, which is why the team always tapers it gradually.
Does norepinephrine interact with other medications?
Yes, and it's important the medical team knows everything the patient has been taking. Two major interactions to be aware of: MAO inhibitors (a type of antidepressant or antibiotic like linezolid) and tricyclic antidepressants (like amitriptyline or imipramine) can both cause severely high blood pressure when combined with norepinephrine. It can also raise blood sugar, which matters for people on diabetes medications. Certain anesthetics used in surgery can increase the risk of dangerous heart rhythms as well.
Is norepinephrine safe to use in pregnancy?
This is a situation where the risk of not treating dangerously low blood pressure — which can be life-threatening for both mother and baby — generally outweighs concerns about the medication. There's limited data in pregnancy, and some animal studies at very high doses showed effects on fetal blood flow, but the doses used in those studies were much higher than what's typically used in people. Doctors won't withhold life-saving treatment during pregnancy, and this decision is always made carefully by the care team.
How fast does norepinephrine work, and how long does it stay in the body?
It works very fast — blood pressure typically responds and reaches a stable level within about 5 minutes of starting the infusion. And it clears out of the body just as quickly: once the infusion is stopped, the blood pressure effect fades within 1 to 2 minutes. This short action time is actually useful, because it gives the medical team precise control over dosing moment to moment.
Will norepinephrine affect blood sugar levels?
It can. Norepinephrine can reduce insulin sensitivity and cause blood sugar to rise. If you or your family member has diabetes or is on insulin or other blood sugar medications, the care team will be monitoring glucose levels closely and may need to adjust those medicines during treatment.
Is Norepinephrine available over the counter?
Both — Norepinephrine is sold both over the counter and by prescription, according to its FDA labeling. Lower strengths or certain forms are often available without a prescription, while higher strengths or specialized forms still require one. Ask your pharmacist which version is right for you.
When was Norepinephrine first available?
Norepinephrine has been available in the United States since at least 1950, based on FDA approval history (Drugs@FDA) and product marketing records.
Who makes Norepinephrine?
Norepinephrine is supplied by 37 manufacturers listed in the FDA NDC Directory, including Baxter Healthcare Corporation, WG Critical Care, LLC, Mylan Institutional LLC.

💬 Answers drafted from Norepinephrine’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Grounded in that labeling — nothing is made up. How we use AI →

🧰 Keep exploring

💊 How Norepinephrine comes

Norepinephrine is available in 2 forms. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.

Injection

Into a vein
Brands Levophed Norepinephrine Bitartrate In Sodium Chloride
How this form is used
What it may be used for
  • Levophed is indicated to raise blood pressure in adult patients with severe, acute hypotension
  • Norepinephrine Bitartrate injection products are indicated to restore blood pressure in adult patients with acute hypotensive states
  • Norepinephrine Bitartrate concentrate is also used as an adjunct in cardiac arrest and profound hypotension, and for blood pressure control in conditions such as septicemia, heart attack, and drug reactions
  • Norepinephrine Bitartrate In Sodium Chloride injection is indicated to raise blood pressure in adult patients with severe, acute hypotension
Important instructions
  • Levophed must be diluted prior to use and infused into a large vein; avoid infusion into leg veins in elderly patients or those with occlusive vascular disease
  • Norepinephrine Bitartrate concentrate must be diluted in 5% dextrose-containing solution before infusion — administration in saline alone is not recommended
  • Norepinephrine Bitartrate In Sodium Chloride is a ready-to-administer product that requires no further dilution prior to infusion
  • For all injection products, the infusion rate must be tapered gradually when stopping — never discontinued abruptly
Available strengths 11 strengths
Show 5 more strengths Show fewer strengths
72 FDA-listed product records

📊 Norepinephrine across the U.S. market

How Norepinephrine appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.

2
Dose forms
37
Manufacturers
6
Brand names
91
FDA-listed product records
1950
First marketed

FDA-listed product records by dose form (tablet variants merged) — FDA National Drug Code Directory. Record counts are not sales or prescription volume.

Also listed with the FDA, not a patient dose form: Powder (6) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.

Baxter Healthcare Corporation18%
WG Critical Care, LLC11%
Mylan Institutional LLC4%
BioActive Nutritional, Inc.4%
Deseret Biologicals, Inc.4%
Amneal Pharmaceuticals LLC3%
Other makers55%

Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.

📈 How widely Norepinephrine is used

A general measure of how commonly Norepinephrine is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.

Think of this as a proxy for how widely Norepinephrine is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.

709
Medicaid prescriptions filled (Q1–Q4 2025)
$93,851 gross Medicaid reimbursement (before mandatory rebates — net cost is lower)

How commonly is Norepinephrine prescribed? Of the 1,596 medications we measure, Norepinephrine ranks #1,328 by Medicaid prescriptions — more than 17% of them.

Where Norepinephrine ranks among the drugs we measure · Q1–Q4 2025 · neighbors ±5

Utilization by Norepinephrine product

Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.

The 250 mL / 0.032 mg/mL injection is the most-dispensed Norepinephrine product — about 59% of these Medicaid prescriptions.

250 ML norepinephrine 0.032 MG/ML Injection Most dispensed

421 Medicaid prescriptions (Q1–Q4 2025) 59% of Norepinephrine prescriptions shown $87,387 gross reimbursement (before rebates) ≈ $208 per prescription (gross)

Summed across the 2 of 7 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 2475340

250 ML norepinephrine 0.016 MG/ML Injection

216 Medicaid prescriptions (Q1–Q4 2025) 30% of Norepinephrine prescriptions shown $4,635 gross reimbursement (before rebates) ≈ $21 per prescription (gross)

Summed across the 2 of 9 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 2475337

4 ML norepinephrine 1 MG/ML Injection

58 Medicaid prescriptions (Q1–Q4 2025) 8% of Norepinephrine prescriptions shown $465 gross reimbursement (before rebates) ≈ $8.02 per prescription (gross)

Summed across the 3 of 61 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 242969

250 ML norepinephrine 0.064 MG/ML Injection

14 Medicaid prescriptions (Q1–Q4 2025) 2% of Norepinephrine prescriptions shown $1,364 gross reimbursement (before rebates) ≈ $97 per prescription (gross)

Summed across the 1 of 7 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 2619579

Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.

Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Norepinephrine, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 8 of 84 listed Norepinephrine NDCs with Medicaid activity.

🔍 Compare Norepinephrine products

A representative set of FDA-listed product records for Norepinephrine — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)

Showing 91 of 91 products — FDA National Drug Code Directory. See every product, package size and price: browse all 91 Norepinephrine NDCs →

RxNorm Concept Web — From Ingredient to Every Form and Strength

This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.

Ingredient (IN) Norepinephrine RxCUI 7512 1 dose form · 5 strengths

Look up RxCUI 7512 in the RxCUI Atlas →

RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.

🏷️ Sold under these brand names

Levophed Norepinephrine Bitartrate In Sodium Chloride Norepinephrine Phenolic

🏭 Manufacturers & labelers

Baxter Healthcare Corporation 16 WG Critical Care, LLC 10 Mylan Institutional LLC 4 BioActive Nutritional, Inc. 4 Deseret Biologicals, Inc. 4 Amneal Pharmaceuticals LLC 3 Long Grove Pharmaceuticals, LLC 3 Hospira, Inc. 3 Energique, Inc. 3 Breckenridge Pharmaceutical, Inc. 3 Sagent Pharmaceuticals 2 Baxter Healthcare Company 2 Teva Parenteral Medicines, Inc. 2 Hikma Pharmaceuticals USA Inc. 2 HF Acquisition Co LLC, DBA HealthFirst 2 Gland Pharma Limited 2 Fresenius Kabi USA, LLC 2 Professional Complementary Health Formulas 2 Civica, Inc. 2 Caplin Steriles Limited 2 Sandoz Inc 2 Sun Pharmaceutical Industries, Inc. 1 Novadoz Pharmaceuticals LLC 1 Rising Pharma Holdings, Inc. 1

…and 13 more on the FDA NDC directory.

RxNorm drug class

Norepinephrine belongs to the Catecholamine class.

Pharmacologic class Catecholamine
Drug family (ATC) Adrenergic and dopaminergic agents

Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.

🔬 Where this comes from

Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.

📄
FDA-filed drug labels (SPL) Uses, dosing, warnings & side effects from SPL records retrieved through openFDA; the linked representative set can be verified on DailyMed. ✓ Linked label effective Feb 6, 2026
🏭
Forms, brands & labelersAggregated from ingredient-matched FDA National Drug Code Directory product records for Norepinephrine.
📈
Real-world reportsThe FDA Adverse Event Reporting System (FAERS), served through openFDA.
🚨
Recalls & shortagesopenFDA drug-enforcement reports and the FDA drug-shortage database.
🧾 Clinical label set — FDA-filed SPL labels retained for Norepinephrine after exact ingredient or ingredient-combination matching and applicable route/form matching
Clinical labels in scope
30
NDC products indexed
91
Distinct labelers/manufacturers represented
37
Linked representative label
Baxter Healthcare Corporation
Linked label effective
Feb 6, 2026
Composite sections available
21
Linked SPL Set ID
6363e9b4-29df-4553-904d-a563e5adda6e
Linked SPL Document ID
b40627c0-67bf-4740-9d21-83054aa6afd9
Open the linked representative label on DailyMed ↗

How we combine label and product data

HelloPharmacist combines public FDA and NLM records; we don’t author the underlying clinical facts. We identified 30 FDA-filed SPL label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. The representative label is the starting point for the displayed reference monograph; the 12 largest stored in-scope SPL records, which may include that representative, are compared section by section, and the longest available version of each section is retained. Forms, routes, brands, labelers, product-listed strengths, and product-record counts are aggregated separately from ingredient-matched FDA NDC Directory records; package records listed above are associated with the linked SPL; and the normalized concept hierarchy comes from NLM RxNorm.

For canonical ingredient pages, bounded product-attributed indication and administration excerpts may be added to the AI evidence, and the generator is instructed to preserve available product, brand, route, and form qualifiers instead of treating one label as universal. Where a section is identified as AI-written, its plain-language text is generated from bounded label evidence. New draft drug pages remain in the admin review queue before first publication. Baxter Healthcare Corporation is the representative DailyMed label linked for verification and dates; it is not the sole source used for the page.

This is general education, not medical advice — always consult your doctor or pharmacist about your medications and any medical condition. For the exact wording of the linked representative label, view that label on DailyMed; some displayed composite sections may come from other in-scope SPL labels. Learn how we use AI and our data sources & update cadence.