INTRODUCTION

NOR EPINEPH 2MG INJECTION contains Noradrenaline which belongs to the group of medicines called Adrenergic and Dopaminergic agents. It is used in emergency conditions to increase blood pressure to normal levels in adults. During NOR EPINEPH 2MG INJECTION treatment, your doctor will monitor your blood pressure, blood volume, heart rate and the infusion site.

NOR EPINEPH 2MG INJECTION is not recommended for use in patients with low blood pressure caused by low blood volume. NOR EPINEPH 2MG INJECTION should be used with caution in patients with liver, heart or kidney disease, blood clots, diabetes or over active thyroid gland.

NOR EPINEPH 2MG INJECTION will be given in pregnancy only if clearly necessary as it may cause harm to unborn baby. It is not known whether NOR EPINEPH 2MG INJECTION pass through the breast milk so it should be used with caution.

The safety and efficacy of NOR EPINEPH 2MG INJECTION in children and adolescents under 18 years of age is not established so, contact your child’s doctor for advice. The most common side effects of NOR EPINEPH 2MG INJECTION are low blood pressure, slow heartbeat, anxiety, headache, etc. Call your doctor if any of the symptoms worsen.

USES OF NOR EPINEPH 2MG INJECTION

• Used in emergency conditions to increase blood pressure to normal levels

HOW NOR EPINEPH 2MG INJECTION WORKS

NOR EPINEPH 2MG INJECTION works by constricting the blood vessels, leading to increase in blood pressure.

DIRECTIONS FOR USE

NOR EPINEPH 2MG INJECTION will be given to you only by a doctor or a nurse into a vein as an intravenous infusion. Dose and duration will be decided by your physician depending upon your age, body weight and disease condition.

SIDE EFFECTS OF NOR EPINEPH 2MG INJECTION

HOW TO MANAGE SIDE EFFECTS

Itchy skin:

Avoid hot showers because hot water can irritate the skin. Do not scratch the affected area. Use sunscreen and protective clothing when outdoors. Use moisturizers to soothe and hydrate the affected skin area. If symptom persists, contact your doctor.

Headache:

Rest and relax. Drink plenty of fluids such as water or electrolytes. Apply a pain-relieving balm on the head if required. Do not consume too much of alcohol. If symptom persists, contact your doctor.

WARNING & PRECAUTIONS

INTERACTIONS

A. Drug-Drug interactions:

Before receiving NOR EPINEPH 2MG INJECTION, inform your doctor if you are taking any of the following medicines:

• medicines used for depression (Ex. fluoxetine, sertraline, selegiline, moclobemide, iproniazid, phenelzine, amitriptyline, nortriptyline, imipramine, desipramine, trimipramine)
• linezolid (used for bacterial infections)
• medicines used during surgery to numb the pain (Ex. halothane, cyclopropane, chloroform, enflurane, propofol)
• orciprenaline (medicine used in the treatment of asthma)
• dobutamine (medicine used for heart diseases)
• medicines used for high blood pressure (Ex. guanethidine, guanadrel, reserpine, methyldopa, prazosin, metoprolol, rauwolfia alkaloids)
• medicines used for irregular heartbeats (Ex. amiodarone, quinidine)
• cardiac glycosides like digoxin (used for heart failure)
• levodopa (medicine used for parkinson’s disease)
• medicines used for thyroid diseases (Ex. levothyroxine)
• oxytocin (medicine used to improve uterine contractions)
• medicines used for allergies (Ex. chlorpheniramine, cetirizine)
• amphetamine (used to increase wakefulness)
• doxapram (used for breathing disorders)
• mazindol (used to treat obesity)
• medicines used to treat migraine (Ex. ergotamine, dihydroergotamine)
• lithium (used to treat mental illness)

Overdosage:

NOR EPINEPH 2MG INJECTION will be administered to you only by a doctor or a nurse in a hospital and so it is unlikely to receive an overdose. However, consult your doctor or nurse if you experience any unusual symptoms like severely high blood pressure, slow heartrate, severe headache, sensitivity to light, chest pain, pale skin, high fever, intense sweating, vomiting or breathlessness.

SYNOPSIS

MORE INFORMATION

• Keep NOR EPINEPH 2MG INJECTION out of reach of children
• Store NOR EPINEPH 2MG INJECTION below 25°C

FAQs ABOUT NOR EPINEPH 2MG INJECTION

What if I miss a dose of NOR EPINEPH 2MG INJECTION?

It is unlikely that you will miss a dose of NOR EPINEPH 2MG INJECTION, as it will be given to you in hospital. However, please stick to the prescribed schedule as agreed with your doctor for optimal efficacy of NOR EPINEPH 2MG INJECTION treatment. Tell your doctor whenever you miss to receive any dose.

Does anaesthesia affect NOR EPINEPH 2MG INJECTION use?

Using NOR EPINEPH 2MG INJECTION with propofol (an anaesthetic) may lead to propofol infusion syndrome (PRIS), which is a serious condition that affects patients who are being sedated with propofol during surgeries. Your doctor would observe disorders in your body’s metabolism from blood tests.

Can NOR EPINEPH 2MG INJECTION be used in pregnancy?

NOR EPINEPH 2MG INJECTION may harm the unborn baby so, if you are pregnant, think you may be pregnant or are planning for a baby, consult your doctor before receiving it. Inform your doctor immediately if you become pregnant during treatment with NOR EPINEPH 2MG INJECTION.

Can NOR EPINEPH 2MG INJECTION be given to children?

No. NOR EPINEPH 2MG INJECTION is used for adults and not recommended for children and adolescents below 18 years of age. Consult your child’s doctor for advice. The doctor will decide a proper dose or select a suitable alternative treatment for your child.

Can I take other medicines with NOR EPINEPH 2MG INJECTION?

Before receiving NOR EPINEPH 2MG INJECTION, inform your doctor if you are taking, have taken or might take any other medicine, including prescription, over the counter or any herbal medicine, as these might lead to significant side effects by interacting with each other.

REFERENCES

1. Brunton L.L., Hilal-Dandan R, Knollmann B.C. Adrenergic Agonists and Antagonists. Goodman & Gilman's: The Pharmacological Basis of Therapeutics. Thirteenth Edition. 2017. Page - 197.

2. Matthew D. Smith, Christopher V. Maani. Norepinephrine. NIH National Library of Medicine, National center for biotechnology information. StatPearls [Internet]. May 2022. [Accessed on 18th August 2022]. https://www.ncbi.nlm.nih.gov/books/NBK537259/

3. Fiorese Coimbra, Karla Tuanny, de Freitas, Flávio Geraldo Rezende, Bafi, Antônio Tonete, Pinheiro, Tuanny Teixeira, Nunes, Nathaly Fonseca, de Azevedo, Luciano César Pontes, Machado, Flávia Ribeiro. Effect of Increasing Blood Pressure With Noradrenaline on the Microcirculation of Patients With Septic Shock and Previous Arterial Hypertension. Critical Care Medicine. August 2019. [Accessed on 18th August 2022]. https://journals.lww.com/ccmjournal/Abstract/2019/08000/Effect_of_Increasing_Blood_Pressure_With.4.aspx

4. Avara Liscate Pharmaceutical Services S.p.A. Electronic Medicines Compendium (EMC). [Revised in August 2022] [Accessed on 18th August 2022]. https://www.medicines.org.uk/emc/files/pil.4115.pdf

5. AS KALCEKS. Health Products Regulatory Authority (HPRA). [Revised in February 2022] [Accessed on 18th August 2022]. https://www.hpra.ie/img/uploaded/swedocuments/f53e6229-5a3d-4f69-9443-3c86ac4be241.pdf

6. Baxter International, Inc. Norepinephrine Bitartrate in Dextrose injection. [Revised in January 2021] [Accessed on 18th August 2022]. https://www.baxterpi.com/pi-pdf/Norepinephrine%20Premix%20PI%20CB-30-02-675%20Jan%202021.pdf

USEFUL DIAGNOSTIC TESTS

• Echocardiogram