1)    Norepirin Injection belongs to a group of medicines called sympathomimetic and vasoconstriction.

2)    Norepirin Injection is used:

-       For acute hypotension caused by various disease or used as a supplementary therapy for shock(shock caused by myocardial infarction or sepsis, anaphylactic shock, acute hypotension or shock caused by hypovolemia, acute hypotension during general anesthesia).

-       As a supplementary therapy for cardiac arrest

Do not take Norepirin Injection

1)    Patients with hypotension due to hypovolemia(except in an emergency case for maintaining coronal and cerebral arterial perfusion until blood volume replacement therapy is completed).

2)    Patients with hypertension(acute increase in blood pressure may occur due to vasoconstriction).

3)    Patients with hyperthyroidism.

4)    Patients with argentaffin chromaffin cell.

5)    Patients with severe renal failure.

6)    Patients with pulmonary heart disease.

7)    Patients with severe arrhythmia(paroxysmal tachycardia etc.).

8)    Patients having anesthesia on finger, toe, nose, or penile part.

9)    Pregnant women or patients having a possibility to be pregnant.

Take special care with Norepirin Injection

1)    In principle, this drug should not be administered to the following patients. Administer carefully when it is required.

-       Patients with cocaine intoxication(cocaine has central and sympathetic irritating actions, and these actions may be increased and the symptoms may become worsen by this drug).

-       Patients with ventricular tachycardia(symptoms may become worsen due to decrease in cardiac output and cerebral blood flow).

2)    Patients with artherosclerosis(blood pressure is increased and peripheral blood volume is decreased).

3)    Patients with heart disease(it may affect on heart function).

4)    Patients with bradycardia(may cause arrhythmia).

5)    Patients with coronary aneurysm, mesentery, or peripheral vascular thrombosis(ischemia or infarction may be increased).

6)    Patients with hypotension due to myocardial infarction.

7)    Patients with prinzmetal angina.

8)    Geriatric patients.

Taking Norepirin Injection with other medicines

Please tell your doctor, health care or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

1)    Do not co-administer since co-administration with inhalation anesthetic containing halogen such as cyclopropane or halothane may increase the risk of occurrence of tachycardia, ventricular fibrillation or acute pulmonary edema.

2)    Do not co-administer since co-administration with catecholaminergic drugs like isoprenaline or with drugs having the effect of epinephrine like proterenol may cause cardiac arrhythmia and cardiac arrest in some cases. Do not co-administer with these drugs except for the emergency care such as resuscitation.

3)    Co-administration with MAO inhibitor, tricyclic antidepressant, partrifacient(oxytocin, ergotamine, etc), antihistamine(chlorpheniramine, tripelennamine, etc) may increase the action of this drug and cause abnormal increase in blood pressure.

4)    Be cautious since co-administration with thyroid agent(thyroxin, etc.) may cause paroxysmal coronary insufficient.

5)    Be cautious since co-administration may reduce the action of hypoglycemic agent like insulin.

6)    Be cautious since co-administration with guanethidine may cause prominent increase in arterial pressure.

7)    Be cautious since co-administration with spironolactone may reduce the blood reactivity of this drug.

Pregnancy and breast-feeding

1)    Constriction of uterine blood vessel may cause suspended animation of the fetus. Do not administer this drug to pregnant women and patients having a possibility to be pregnant.

2)    Excretion of this drug into human milk is not known.  Be careful when administer this drug to nursing mothers.

Geriatric patient

Administer carefully since this drug may cause excessive increase in blood pressure.

Always take Norepirin Injection exactly as your doctor or health care provider has told you. You should check with your doctor, health care provider or pharmacist if you are not sure.

1)    Acute hypotension or shock

-       For single dose, as norepinephrine bitartrate, dilute 8mg(as norepinephrine 4mg) in 1,000mL of dextrose 5% injection or sodium chloride 5% injection, and administer in a ratio of 2~3mL/min. by intravenous drip. Monitor closely while administering and increase or decrease the dose. The maintenance dose is 0.5~1.0mL/min. and this is different with each individual.

2)    Cardiac arrest

-       During the cardiac resuscitation, secure effective heart beat with ventilation, then administer intravenously same as for acute hypotension or shock.

General precaution

1)    Principle of emergency treatment for shock is to have ventilation, fluid, and increasing cardiac output and blood pressure. Movement cycle of shock is different with the cause and state of disease, so be careful when using vasopressor. This drug is used for increasing blood pressure as an emergency care and is not a substitution drug for transfusion or fluid.

2)    This drug may cause excessive increase in blood pressure and may cause acute pulmonary edema, arrhythmia or cardiac arrest. Be careful not to have overdose.

3)    When inject, monitor blood pressure and injection rate frequently to prevent hypertension.

4)    When this drug is continuously used to maintain the blood pressure without blood substitute, prominent peripheral and splanchnic vasoconstriction, reduction of renal perfusion and urine emission, reduction of whole body blood volume in patients with normal blood pressure, tissue hypoxia or metabolic acidosis may occur. Use this drug only when appropriate blood substitute is ready.

5)    Use a-blocker(phentolamine) if blood pressure increased excessively.

Caution for application

1)    When inject intravenously, be careful not to cause abnormal increase in blood pressure.

2)    When inject by intravenous drip, local ischemic necrosis may occur when significant amount of injection solution flows out of blood vessel, so monitor the injection area frequently. Immediately administer phentolamine when injection solution flows out of blood vessel.

3)    Dilute this drug in Dextrose 5% injection or Sodium Chloride injection(these may inhibit the reduction of potency of this drug).

4)    Do not mix the infusion containing this drug with alkalic agent, oxidizing agent, barbital agent, chlorpheniramine, chlorothiazide, nitrofurantoin, novobiocin, phenytoin, sodium bicarbonate, sodium iodide or streptomycin.

If you take more Norepirin Injection than you should

Severe hypertension, decrease in cardiac output, increase in peripheral resistance, reflex bradycardia, photophobiaIn occurrence of these symptoms, discontinue the administration until the patient recovers and take an appropriate action.

If you have any further question on the use of this product, ask your doctor, health care provider or pharmacist.

Like all medicines, Norepirin Injection can cause side effects, although not everybody gets them.

1)    Ampoule injection may cause side effects if glass fragments are mixed with the injection solution. Be careful when cutting the ampoule particularly when it is administered to pediatric and geriatric patients.

2)    Cardiovascular system: palpitation, bradycardia(this is recovered easily with atropine) or occasionally endothoracic pain, abnormal increase in blood pressure, cardiac arrhythmia(when patients, particularly patients with hypoxia or hypercapnia, co-administer with heart-sensitive drugs), or peripheral ischemia such as limb gangrene may occur.

3)    Psychoneurotic system: occasionally headache, dizziness, delirium tremens or anxiety may occur.

4)    Digestive system: occasionally nausea, vomiting, etc may occur.

5)    Respiratory system: respiratory distress may occur.

6)    Skin: necrosis on injection area may occur(may cause extravasation).

7)    Others: long-term administration may deplete the plasma volume.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor, health care provider or pharmacist.

1)    Keep out of the reach and sight of children.

2)    Do not store above 30°c.

3)    Store in the light protected hermetically sealed container.

4)    Do not use Norepirin Injection after the expiry date which is stated on the case. The expiry date refers to the last day of that month.