Vasopressin

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General

Adult Dosing

Dosing

  • 0.01-0.04 units/min (typically 0.03 or 0.04 U/min)

Rate of Titration

  • Fixed dose (do not titrate)

Pediatric Dosing

0.0002–0.008 U/kg/min have been studied although no current consensus on dosage [1]

Special Populations

  • Pregnancy Rating:
  • Lactation:
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug

Adverse Reactions

  • Bradycardia
  • Limb ischemia
  • Myocardial ischemia
  • Splanchnic ischemia

Pharmacology

  • Half-life: <20 minutes [2]
  • Metabolism: liver, kidney extensively; CYP450: unknown
  • Excretion: urine (5-6% unchanged)
  • Mechanism of Action: "directly stimulates V1 and V2 receptors, resulting in vasoconstriction and antidiuresis" [3]

Primary Receptor

  • V1

Relative Effects

  • ↑SVR
  • ↓HR

Notes

  • Adverse effects are dose-dependent
  • Acts on V1 receptors leading to ↑vasoconstriction and

↑sensitivity to catecholamines in patients with shock

Indication

  • Adjunct for septic shock VASST trial [4]
    • no difference in mortality when vasopressin was added as second line pressor compared to norepinephrine
    • subgroup analysis found that patients with less severe septic shock did better with vasopressin

See Also

http://www.atsjournals.org/doi/abs/10.1164/rccm.201006-0972CI?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#readcube-epdf

References

  1. https://pdfs.semanticscholar.org/9f71/beefc10500d2d3a14d338d7b86b076729d3b.pdf
  2. https://online.epocrates.com/u/1072232/vasopressin
  3. https://online.epocrates.com/u/1072232/vasopressin
  4. http://www.nejm.org/doi/full/10.1056/NEJMoa067373