Posology : מינונים

5.   DOSAGE AND ADMINISTRATION
Noradrenaline tartrate Injection is a concentrated, potent drug which must be diluted prior to infusion. An infusion of Noradrenaline Kalceks should be given into a large vein (see Warnings and PRECAUTIONS).
Restoration of Blood Pressure in Acute Hypotensive States
Blood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, Noradrenaline Kalceks can be administered before and concurrently with blood volume replacement.
Diluent: Noradrenaline Kalceks should be diluted in sodium chloride 9 mg/ml (0.9%) solution or glucose 50 mg/ml (5%) solution, or sodium chloride 9 mg/ml (0.9%) with glucose 50 mg/ml (5%) solution. Whole blood or plasma, if indicated to increase blood volume, should be administered separately (for example, by use of a Y-tube and individual containers if given simultaneously).
Average Dosage: Add a 4 ml ampoule (4 mg) of Noradrenaline Kalceks to 1,000 ml of a sodium chloride 9 mg/ml (0.9%) solution or glucose 50 mg/ml (5%) solution, or sodium chloride 9 mg/ml (0.9%) with glucose 50 mg/ml (5%) solution. Each ml of this dilution contains 4 mcg of the base of noradrenaline. Give this solution by intravenous infusion. Insert a plastic intravenous catheter through a suitable bore needle well advanced centrally into the vein and securely fixed with adhesive tape, avoiding, if possible, a catheter tie-in technique as this promotes stasis. An IV drip chamber or other suitable metering device is essential to permit an accurate estimation of the rate of flow in drops per minute.
After observing the response to an initial dose of 2 ml to 3 ml (from 8 mcg to 12 mcg of noradrenaline base) per minute, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 mm Hg to 100 mm Hg systolic) sufficient to maintain the circulation to vital organs. In previously hypertensive patients, it is recommended that the blood pressure should be raised no higher than 40 mm Hg below the preexisting systolic pressure. The average maintenance dose ranges from 0.5 ml to 1 ml per minute (from 2 mcg to 4 mcg of noradrenaline base).
High Dosage: Great individual variation occurs in the dose required to attain and maintain an adequate blood pressure. In all cases, dosage of Noradrenaline Kalceks should be titrated according to the response of the patient. Occasionally much larger or even enormous daily doses (as high as 68 mg noradrenaline base or 17 ampoules) may be necessary if the patient remains hypotensive, but occult blood volume depletion should always be suspected and corrected when present. Central venous pressure monitoring is usually helpful in detecting and treating this situation.
Fluid Intake: The degree of dilution depends on clinical fluid volume requirements. If large volumes of fluid (glucose) are needed at a flow rate that would involve an excessive dose of the pressor agent per unit of time, a solution more dilute than 4 mcg per ml should be used. On the other hand, when large volumes of fluid are clinically undesirable, a concentration greater than 4 mcg per ml may be necessary.
Duration of Therapy: The infusion should be continued until adequate blood pressure and tissue perfusion are maintained without therapy. Infusions of Noradrenaline Kalceks should be reduced gradually, avoiding abrupt withdrawal. In some of the reported cases of vascular collapse due to acute myocardial infarction, treatment was required for up to six days.
Adjunctive Treatment in Cardiac Arrest
Infusions of Noradrenaline Kalceks are usually administered intravenously during cardiac resuscitation to restore and maintain an adequate blood pressure after an effective heartbeat and ventilation have been established by other means. [Noradrenaline Kalceks’s powerful beta-adrenergic stimulating action is also thought to increase the strength and effectiveness of systolic contractions once they occur.]
Average Dosage: To maintain systemic blood pressure during the management of cardiac arrest, Noradrenaline Kalceks is used in the same manner as described under Restoration of Blood Pressure in Acute Hypotensive States.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to use.
Do not use the solution if it has a brown color or if it contains a precipitate. Avoid contact with iron salts, alkalis, or oxidizing agents.
This medicinal product must not be mixed with other medicinal products except those mentioned in section 15.
The product is compatible with polyvinyl chloride (PVC), ethyl vinyl acetate (EVA) or polyethylene (PE) infusion bags.