• Stefano Salvati, Jacopo D'Andria Ursoleo, Alessandro Belletti, Giacomo Monti, Matteo Aldo Bonizzoni, Maria Fazio, and Giovanni Landoni.
• Hospital Pharmacy, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 1; 38 (11): 262426292624-2629.

ObjectivesNorepinephrine is available commercially in solution containing its salt (eg, tartrate), but only the base form (ie, norepinephrine base) is active pharmacologically. Unfortunately, the outer label of drug packages frequently reports the dosage of norepinephrine as a salt, which can lead potentially to therapeutic errors when prescribing norepinephrine. We performed a survey to assess the level of awareness of this issue.DesignNational survey.SettingAcute care units of Italian hospitals.ParticipantsAcute care physicians and nurses.InterventionsA 15-item online survey was emailed to 305 critical care practitioners in Italy. Questions included information on the participants' background, methods of diluting norepinephrine, interpretation of recommended doses from guidelines, and a sample case related to the preparation and administration of the drug.Measurements And Main ResultsWe collected 106 responses from 54 hospitals. All hospitals used norepinephrine bitartrate salt. Of the participants, 53% responded that the guidelines express norepinephrine dosages as a salt, 23% as the base form, and 24% were unsure or unaware about it. The simulated patient-dose calculation was resolved in 81% of cases with an incorrect calculation referring to the norepinephrine salt and only in 19% referring to the norepinephrine base.ConclusionsThere is significant variability in dosage management of norepinephrine across different hospital units, as well as a lack of knowledge regarding the salt-to-base ratio. Scientific publications (eg, guidelines) should specify whether they are referring to the base or salt form of norepinephrine. The adoption of different labeling and national standards for dilution may decrease the risk of therapeutic errors.Copyright © 2024 Elsevier Inc. All rights reserved.

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