Vasopressin

PITRESSIN

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Vasopressin ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Vasopressin ballicule

What it isEndogenous antidiuretic hormone with V1 vasoconstriction; vasodilatory shock and diabetes insipidus.

Why this oneIt works through a receptor unaffected by acidosis, so it is added when catecholamines are failing.

What limits itDigital and mesenteric ischemia at higher doses. Hyponatremia from V2 antidiuresis.

Vasopressin molecular structure (skeletal formula) — Molecular structure: Vasopressin

FDA-approved for

vasodilatory shock/DI (~2014)

FDA label

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FDA dosing	Population	Start	Target	Max
Vasodilatory shock (post-cardiotomy) — increase blood pressure	Adults	0.03 units/min IV	Titrate up by 0.005 units/min every 10–15 min to target BP	Limited data above 0.1 units/min
Vasodilatory shock (septic shock) — increase blood pressure	Adults	0.01 units/min IV	Titrate up by 0.005 units/min every 10–15 min to target BP	Limited data above 0.07 units/min

Renal Undefined

Hepatic Undefined

Continuous IV infusion titrated every 10–15 min

Instructions

Dilute to 0.1 or 1 unit/mL with NS or D5W for IV infusion (premixed bags need no dilution)
Continuous IV infusion; titrate to lowest effective dose
After target BP maintained 8 h without catecholamines, taper by 0.005 units/min every hour as tolerated
Discard diluted solution after 18 h at room temperature or 24 h refrigerated

Available strengths

inj 0.2, 0.4, 20 [usp'u]/ml

Cautions

Can worsen cardiac function (decreased cardiac index)
Reversible diabetes insipidus after discontinuation — monitor electrolytes, fluid status, urine output

Adverse reactions

Decreased cardiac output
Bradycardia
Tachyarrhythmias
Hyponatremia
Ischemia (coronary, mesenteric, skin, digital)
Mesenteric ischemia
Distal limb ischemia

Pregnancy No human data; may produce tonic uterine contractions; clearance increases in 2nd/3rd trimester (dose may need increasing)

Lactation No data on presence in milk

Cost

Vasopressin (PITRESSIN)

Strength		#/mo	CostPlus
0.2 [usp'u]/ml	inj	per unit	not offered
0.4 [usp'u]/ml	inj	per unit	not offered
20 [usp'u]/ml	inj	per unit	not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Vasopressin is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal riskDigital and mesenteric ischemia at higher doses

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityWater intoxication and coronary/peripheral ischemia

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