What do you use LEVOPHED for?: A Comprehensive Guide to Norepinephrine

October 9, 2025 •

3 min read

As a potent vasoconstrictor and cardiac stimulant, LEVOPHED, the brand name for norepinephrine, is often a first-line treatment in intensive care settings for acute hypotensive states. This critical medication helps restore and maintain blood pressure in patients suffering from severe shock.

Quick Summary

Levophed (norepinephrine) is an injectable medication used in critical care to increase blood pressure during severe, acute hypotension and various forms of shock, such as septic or cardiogenic shock, often when fluid resuscitation has failed.

Key Points

Primary Use: LEVOPHED is a vasopressor used to treat life-threatening low blood pressure (hypotension) in acute shock states.
Mechanism: It works by constricting blood vessels and stimulating the heart to raise blood pressure and increase cardiac output.
Administration: The drug is administered as a continuous intravenous infusion under strict medical supervision, with the dosage adjusted based on patient response.
Hypovolemia: Any existing blood volume depletion should be corrected, if possible, before or concurrently with LEVOPHED to avoid severe vasoconstriction.
Extravasation Risk: Infusion into a large vein is critical, as leakage of LEVOPHED outside the vein can cause tissue damage and necrosis.
Serious Side Effects: Potential adverse effects include cardiac arrhythmias, anxiety, headache, and severe peripheral vasoconstriction.
First-line for Septic Shock: Many clinical guidelines recommend LEVOPHED as the initial vasopressor of choice for patients with septic shock.

What is LEVOPHED (Norepinephrine)?

LEVOPHED is a brand name for norepinephrine, a natural hormone and neurotransmitter classified as a vasopressor. It constricts blood vessels to raise blood pressure and is administered intravenously in critical care settings for serious, life-threatening conditions.

Indications: When is LEVOPHED Used?

LEVOPHED is used to restore blood pressure in adults with severe, acute hypotension unresponsive to fluid resuscitation. It is vital in various types of shock, but correcting depleted blood volume is a priority before or during its use. Common indications include Septic Shock, Cardiogenic Shock, Neurogenic Shock, Hypotension from Anesthesia, and Adjunct in Cardiac Arrest.

Mechanism of Action: How LEVOPHED Works

LEVOPHED is a sympathomimetic that mimics the body's stress hormones by acting on adrenergic receptors. Its effects include Alpha-1 Adrenergic Receptor Agonism, causing vasoconstriction and raising blood pressure, and Beta-1 Adrenergic Receptor Agonism, modestly increasing heart rate and contractility. This combined action makes LEVOPHED a highly effective vasopressor.

Administration and Monitoring

Administered in a controlled medical setting, LEVOPHED requires careful preparation and constant monitoring. LEVOPHED is a concentrated injection requiring dilution, typically in 5% dextrose solution. It should be infused into a large vein, preferably a central line, to minimize tissue damage risk from vasoconstriction. Avoid leg veins, especially in the elderly. Dosage is adjusted based on the patient's blood pressure response with continuous vital sign monitoring. The infusion rate is gradually reduced to prevent a sudden drop in blood pressure.

Risks, Side Effects, and Precautions

LEVOPHED carries significant risks despite its life-saving use. Potential Adverse Effects include Tissue Ischemia and Necrosis, Cardiac Arrhythmias, and Peripheral and Visceral Vasoconstriction. Common Side Effects include headache, anxiety, and breathing difficulty. Important Precautions involve correcting hypovolemia, considering drug interactions (like with MAO inhibitors), and noting the presence of sodium metabisulfite which may cause allergic reactions.

LEVOPHED vs. Other Vasopressors

Choice of vasopressor depends on the patient's condition. Here's a comparison with common alternatives:


Feature	LEVOPHED (Norepinephrine)	Dopamine	Epinephrine (Adrenaline)
Primary Mechanism	Potent alpha-1 vasoconstriction with moderate beta-1 cardiac stimulation.	Dose-dependent effects: low doses increase renal blood flow; moderate doses cause beta-1 stimulation; high doses cause alpha-1 vasoconstriction.	Potent alpha- and beta-adrenergic stimulation.
Effect on Blood Pressure	Strong increase due to vasoconstriction.	Can increase blood pressure, but less consistently than LEVOPHED, with higher risk of arrhythmias.	Strong increase in blood pressure.
Effect on Heart	Moderate increase in contractility and heart rate.	Increases heart rate and contractility at moderate doses.	Significant increase in heart rate and contractility.
First-Line for Septic Shock?	Yes, widely recommended as the first-line vasopressor.	No, associated with a higher risk of arrhythmias.	No, often reserved for cases where LEVOPHED is insufficient.
Side Effect Concerns	Tissue ischemia, extravasation necrosis.	Tachyarrhythmias.	Tachyarrhythmias, increased myocardial oxygen demand.

Conclusion

LEVOPHED is a critical medication in emergency and critical care, essential for managing severe hypotension and shock. It primarily raises blood pressure through vasoconstriction and improves cardiac output. Its administration is a carefully monitored intravenous infusion, requiring constant vigilance for potential side effects like tissue ischemia and cardiac arrhythmias. The decision to use LEVOPHED is based on the patient's condition and hemodynamic response.

Learn More About Critical Care

For further information on critical care pharmacology, you can consult authoritative resources such as the {Link: FDA's Drug Approval and Labeling information https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/007513s045lbl.pdf}.

Frequently Asked Questions

LEVOPHED is used for acute hypotensive states resulting from conditions such as septic shock, cardiogenic shock, trauma, severe infection (septicemia), and certain drug reactions.

Yes, LEVOPHED is a brand name for the generic drug norepinephrine bitartrate.

LEVOPHED is always administered as a continuous intravenous infusion, typically through a central venous catheter in a hospital setting, and never as a bolus injection.

One of the most serious side effects is tissue ischemia and necrosis, which can occur if the medication leaks out of the vein, causing severe local vasoconstriction and damage to surrounding tissue.

Precautions include correcting hypovolemia before starting the infusion, using a large vein, and continuously monitoring vital signs and the infusion site. Abrupt withdrawal should also be avoided.

Yes, LEVOPHED can be used as an adjunct during cardiac resuscitation to restore and maintain blood pressure after an effective heartbeat has been established by other means.

Yes, in addition to constricting blood vessels, LEVOPHED has a modest beta-1 adrenergic effect, which stimulates the heart and increases contractility.