First-lineNoradrenaline
Norepinephrine
α1-adrenergic vasopressor
First-line vasopressor in obstetric septic shock and haemorrhagic vasoplegia.
Central IV infusion (peripheral short-term acceptable in emergency)
First-line for
- Septic shock in pregnancy/postpartum
- Vasoplegia post PPH resuscitation
Mechanism
Potent α1 agonism with modest β1 → vasoconstriction with preserved cardiac output.
"NAd = Now A driver — go central"
- MAP target ≥65 mmHg (higher if chronic HTN)
- Requires central access ideally
- Avoid extravasation — phentolamine antidote
Dosing
- Start
- 0.05 μg/kg/min IV
- Titrate
- By 0.05 μg/kg/min every 5 min to MAP ≥65
Contraindications
- AbsoluteHypovolaemia without concurrent fluid resuscitation
Side effects
- Peripheral / mesenteric ischaemia
- Reflex bradycardia
- Extravasation necrosis
- Arrhythmias
Fetal & maternal notes
- • Maintaining maternal BP protects uteroplacental perfusion — treat maternal shock aggressively
Key interactions
MAOIs, TCAs
AvoidExaggerated pressor response
Clinical pearls
- 💡 Add vasopressin (0.03 U/min) if refractory sepsis
- 💡 Start earlier in sepsis than fluids-alone protocols suggest
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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