Metaraminol
lINDICATIONS AND DOSE
Acute hypotension
▶BY INTRAVENOUS INFUSION
▶Child 12–17 years: 15 – 100 mg, adjusted according to
response
Emergency treatment of acute hypotension
▶INITIALLY BY INTRAVENOUS INJECTION
▶Child 12–17 years:Initially 0. 5 – 5 mg, then (by
intravenous infusion) 15 – 100 mg, adjusted according
to responselUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSHypertension
lCAUTIONSCirrhosis.coronary vascular thrombosis.
diabetes mellitus.extravasation at injection site may
cause necrosis.following myocardial infarction.
hypercapnia.hyperthyroidism.hypoxia.mesenteric
vascular thrombosis.peripheral vascular thrombosis.
Prinzmetal’s variant angina.susceptibility to angle-
closure glaucoma.uncorrected hypovolaemia
CAUTIONS, FURTHER INFORMATION
▶Hypertensive responseMetaraminol has a longer duration of
action than noradrenaline, and an excessive vasopressor
response may cause a prolonged rise in blood pressure.
lINTERACTIONS→Appendix 1 : sympathomimetics,
vasoconstrictor
lSIDE-EFFECTS
▶Common or very commonHeadache.hypertension
▶Rare or very rareSkin exfoliation.soft tissue necrosis
▶Frequency not knownAbscess.arrhythmias.nausea.
palpitations.peripheral ischaemia
lPREGNANCYMay reduce placental perfusion—
manufacturer advises use only if potential benefit
outweighs risk.
lBREAST FEEDINGManufacturer advises caution—no
information available.
lMONITORING REQUIREMENTSMonitor blood pressure and
rate offlow frequently.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, dilute to a concentration of
30 – 200 micrograms/mL with Glucose 5 % or Sodium
Chloride 0. 9 % and give through a central venous catheter.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: solution for injection
Solution for injection
▶Metaraminol (Non-proprietary)
Metaraminol (as Metaraminol tartrate) 10 mg per
1mlMetaraminol 10 mg/ 1 ml solution for injection ampoules|
10 ampouleP£ 39. 40Noradrenaline/norepinephrine 03-Apr-2018
lINDICATIONS AND DOSE
Acute hypotension (septic shock)|Shock secondary to
excessive vasodilation
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Neonate: 20 – 100 nanograms/kg/minute (max. per dose
1 microgram/kg/minute), adjusted according to
response, dilute the 1 mg/mL concentrate for infusion
for this dose.▶Child: 20 – 100 nanograms/kg/minute (max. per dose
1 microgram/kg/minute), adjusted according toresponse, dilute the 1 mg/mL concentrate for infusion
for this dose
DOSE EQUIVALENCE AND CONVERSION
▶ 1 mg of noradrenaline base is equivalent to 2 mg of
noradrenaline acid tartrate.Doses expressed as the
base.lUNLICENSED USENot licensed for use in children.IMPORTANT SAFETY INFORMATION
ASSOCIATION OF NORADRENALINE/NOREPINEPHRINE
0.08 MG/ML (4 MG IN 50 ML) SOLUTION FOR INFUSION WITH
POTENTIAL RISK OF MEDICATION ERRORS
Healthcare professionals should be aware of the
differences in strength and presentation between
noradrenaline/norepinephrine products—manufacturer
advises
noradrenaline 0. 08 mg/mL solution for infusion must
notbe diluted before use and should only be used for the
on-going treatment of patients already established on
noradrenaline therapy,
whose dose requirements are clinically confirmed to be
escalating.lCONTRA-INDICATIONSHypertension
lCAUTIONSCoronary vascular thrombosis.diabetes
mellitus.extravasation at injection site may cause
necrosis.following myocardial infarction.hypercapnia.
hyperthyroidism.hypoxia.mesenteric vascular
thrombosis.peripheral vascular thrombosis.Prinzmetal’s
variant angina.susceptibility to angle-closure glaucoma.
uncorrected hypovolaemia
lINTERACTIONS→Appendix 1 : sympathomimetics,
vasoconstrictor
lSIDE-EFFECTSAnxiety.arrhythmias.dyspnoea.
extravasation necrosis.headache.hypertension.
hypovolaemia.peripheral ischaemia
lPREGNANCYManufacturer advises use if potential benefit
outweighs risk—may reduce placental perfusion and
induce fetal bradycardia.
lMONITORING REQUIREMENTSMonitor blood pressure and
rate offlow frequently.
lDIRECTIONS FOR ADMINISTRATIONForcontinuous
intravenous infusion, using 1 mg/mL concentrate for
infusion, dilute to a max. concentration of noradrenaline
(base) 40 micrograms/mL (higher concentrations can be
used iffluid-restricted) with Glucose 5 % or Sodium
Chloride and Glucose. Infuse through central venous
catheter; discard if discoloured. Incompatible with
bicarbonate or alkaline solutions.
▶In neonatesForneonatal intensive care, using 1 mg/mL
concentrate for infusion, dilute 600 micrograms (base)/kg
body-weight to afinal volume of 50 mL with infusionfluid;
an intravenous infusion rate of 0. 1 mL/hour provides a
dose of 20 nanograms (base)/kg/minute; infuse through
central venous catheter; max. concentration of
noradrenaline (base) 40 micrograms/mL (higher
concentrations can be used iffluid-restricted). Discard if
discoloured. Incompatible with bicarbonate or alkaline
solutions.
lPRESCRIBING AND DISPENSING INFORMATIONFor a period
of time, preparations on the UK market may be described
as either noradrenaline base or noradrenaline acid
tartrate; doses in the BNF are expressed as the base.124 Blood pressure conditions BNFC 2018 – 2019
Cardiovascular system2