Phentolamine (Regitine) is the antidote for norepinephrine extravasation, which is the leakage of the

vasopressor from the vein into the surrounding tissue. Phentolamine reverses the vasoconstriction

and ischemia caused by norepinephrine by blocking the alpha-adrenergic receptors. Phentolamine

should be administered intradermally around the site of extravasation as soon as possible, and the

infusion should be stopped but the IV catheter should not be removed until some of the

norepinephrine is aspirated. A warm compress may worsen the tissue damage by increasing the

absorption of norepinephrine, and lowering the extremity may increase the edema and pain.

Removing the IV immediately may prevent the aspiration of norepinephrine and the administration

of phentolamine.

Reference:

Episode 240: What to do with norepinephrine extravasation: This article explains the steps to take

when norepinephrine extravasates, including the use of phentolamine, and the reasons to avoid cold

compress, lowering the extremity, and removing the IV.

What are current recommendations for treatment of drug extravasation?: This article summarizes

the latest recommendations for treatment of extravasation, and lists phentolamine as the immediate

topical therapy for norepinephrine extravasation.