Vasopressin: Difference between revisions
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==General== | ==General== | ||
*Type: [[Vasopressors]] | *Type: [[Is DrugClass::Vasopressors]] | ||
*Dosage Forms: | *Dosage Forms: | ||
*Common Trade Names: | *Common Trade Names: Vasostrict (USA) | ||
==Adult Dosing== | ==Adult Dosing== | ||
===Dosing=== | ===Dosing=== | ||
*0.04 units/min | *0.01-0.04 units/min (typically 0.03 or 0.04 U/min) | ||
===Rate of Titration=== | ===Rate of Titration=== | ||
*Fixed dose (do not titrate) | *Fixed dose (do not titrate) | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
0.0002–0.008 U/kg/min have been studied although no current consensus on dosage | 0.0002–0.008 U/kg/min have been studied although no current consensus on dosage <ref>https://pdfs.semanticscholar.org/9f71/beefc10500d2d3a14d338d7b86b076729d3b.pdf </ref> | ||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*Lactation: | *Lactation: | ||
*Renal Dosing | *Renal Dosing | ||
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==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: <20 minutes <ref> https://online.epocrates.com/u/1072232/vasopressin </ref> | ||
*Metabolism: | *Metabolism: liver, kidney extensively; CYP450: unknown | ||
*Excretion: | *Excretion: urine (5-6% unchanged) | ||
*Mechanism of Action: | *Mechanism of Action: "directly stimulates V1 and V2 receptors, resulting in vasoconstriction and antidiuresis" <ref> https://online.epocrates.com/u/1072232/vasopressin </ref> | ||
===Primary Receptor=== | ===Primary Receptor=== | ||
*V1 | *V1 | ||
===Relative Effects=== | ===Relative Effects=== | ||
*↑SVR | *↑SVR | ||
*↓HR | *↓HR | ||
==Notes== | ==Notes== | ||
*Adverse effects are dose-dependent | *Adverse effects are dose-dependent | ||
*Acts on V1 receptors leading to ↑vasoconstriction and | *Acts on V1 receptors leading to ↑vasoconstriction and | ||
↑sensitivity to catecholamines in patients with shock | *↑sensitivity to catecholamines in patients with shock | ||
*in contrast to catecholamine vasopressors (e.g. [[epinephrine]], [[norepinephrine]]), vasopressin does not lose efficacy at low pH | |||
===Indication=== | ===Indication=== | ||
*Adjunct for septic shock | *Adjunct for septic shock VASST trial <ref> http://www.nejm.org/doi/full/10.1056/NEJMoa067373 </ref> | ||
**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== | ==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== | ==References== | ||
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[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:Critical Care]] | |||
Latest revision as of 16:02, 25 July 2025
General
- Type: Vasopressors
- Dosage Forms:
- Common Trade Names: Vasostrict (USA)
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: C
- 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
- in contrast to catecholamine vasopressors (e.g. epinephrine, norepinephrine), vasopressin does not lose efficacy at low pH
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