Vasostrict (vasopressin)
Antidiuretic Hormone Intravenous Infusion Bottle (ML)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Vasopressin (antidiuretic hormone (ADH)) is a polypeptide hormone; the primary physiologic role of vasopressin is to maintain serum osmolality within a normal range, but the hormone also causes vasoconstriction.
Commercially available vasopressin injection is an aqueous solution of synthetic arginine vasopressin. Vasopressin is a polypeptide hormone. Vasopressin induces vasoconstriction through activation of V1 receptors on vascular smooth muscle cells.
These receptors are coupled to the Gq/11-phospholipase C-phosphatidylinositol trisphosphate signaling pathway, leading to mobilization of intracellular calcium. Additionally, vasopressin promotes antidiuretic effects through stimulation of V2 receptors coupled to adenyl cyclase.
At therapeutic doses, vasopressin elicits a vasoconstrictive effect in most vascular beds, including the splanchnic, renal, and cutaneous circulation. At pressor doses, vasopressin triggers contraction of smooth muscles in the GI tract mediated by muscular V1 receptors and release of prolactin and adrenocorticotropic hormone (ACTH) via V3 receptors. At lower concentrations typical for its role as an antidiuretic hormone, vasopressin suppresses water diuresis via renal V2 receptors.
Furthermore, vasopressin has been shown to induce vasodilation in multiple vascular beds via mechanisms mediated by V2, V3, oxytocin, and purinergic P2 receptors.
When administered in therapeutic doses to patients with vasodilatory shock, vasopressin increases systemic vascular resistance and mean arterial pressure (MAP). In addition, the medication tends to decrease heart rate and cardiac output. The pressor effect of vasopressin is dose dependent.
No evidence of tachyphylaxis or tolerance to the pressor effect of vasopressin has been observed.
Onset of the pressor effect is rapid, with peak effects occurring within 15 minutes. Plasma concentrations of vasopressin increase linearly with increasing infusion rates from 10-200 microU/kg per minute. Steady state plasma concentrations are achieved after 30 minutes of continuous IV infusion.
Pressor effects fade within 20 minutes following discontinuation of IV infusion.
There is no evidence of plasma protein binding with vasopressin. Vasopressin is cleaved by serine protease, carboxipeptidase, and disulfide oxidoreductase at relevant sites for its pharmacologic activity; resulting metabolites are not expected to be pharmacologically active. When administered by IV infusion at usual rates for vasodilatory shock (e.g., 0.1-1 units/minute), the apparent half-life is 10 minutes or less.
Vasopressin is predominantly metabolized and only about 6% of the dosage is excreted unchanged into urine.
Generic name: vasopressin
Drug class: Antidiuretic Hormone
Therapeutic class: Endocrine
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Vasostrict
Indications
The following indications are listed for Vasostrict:
- Hypotension Due To Distributive Shock
Dosing
No dosing information is available for this tab.
Vasopressin is administered by IV infusion for vasodilatory shock. Vasopressin has been administered by IM+ or subcutaneous+ injection for other uses (e.g., diabetes insipidus).
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
*Known allergy or hypersensitivity to synthetic vasopressin (8-L-arginine vasopressin).
*Known allergy or hypersensitivity to chlorobutanol (a preservative) for the chlorobutanol-containing formulations only.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
- Chronic heart failure
- Coronary artery disease
Adverse reactions
The most common adverse effects of vasopressin include decreased cardiac output, bradycardia, tachyarrhythmias, hyponatremia, and ischemia (coronary, mesenteric, skin, digital).
More Frequent
- Hyponatremia
- Low cardiac output
- Myocardial ischemia
- Tachyarrhythmia
Rare or Very Rare
- Atrial fibrillation
- Bradycardia
- Diabetes insipidus
- Distal limb ischemia
- Gastrointestinal vascular ischemia
- Hemorrhage
- Hyperbilirubinemia
- Kidney disease with reduction in glomerular filtration rate (GFr)
- Peripheral ischemia
- Thrombocytopenic disorder
There are no less severe adverse reactions for this drug.
Precautions
No enhanced messaging available.
The manufacturers state the safety and efficacy of vasopressin in pediatric patients with vasodilatory shock have not been established.
There are no available data on vasopressin use in pregnant females to inform a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Animal reproduction studies with vasopressin have not been conducted.
Vasopressin may produce tonic uterine contractions that could threaten the continuation of pregnancy.
Clearance of vasopressin is increased in the second and third trimester of pregnancy; therefore, the dosage of vasopressin may need to be increased.
It is not known whether vasopressin is distributed into human or animal milk. The effects of the medication on the breast-fed infant or on milk production are also unknown.
The manufacturers make no specific dosage recommendations for geriatric patients. In general, dosage should be titrated carefully in geriatric patients, usually initiating therapy at the low end of the dosage range. The greater frequency of decreased renal, hepatic, and/or cardiac function and of concomitant diseases and medication therapies observed in the elderly should also be considered.
Clinical studies of vasopressin did not include sufficient numbers of patients 65 years of age and older to determine whether geriatric patients respond differently than younger patients. Clinical experience to date has not identified any differences in response between geriatric and younger patients.
In general, dosage selection in geriatric patients should be cautious, usually starting at the low end of the dosage range, since renal, hepatic, and/or cardiovascular dysfunction and concomitant diseases and other medication therapies are common in this age group.
ICD codes
| Code | Type | Description |
|---|---|---|
| Hypotension due to distributive shock | ||
| A48.3 | ICD10CM | Toxic shock syndrome |
| E27.2 | ICD10CM | Addisonian crisis |
| I95 | ICD10CM | Hypotension |
| R65.21 | ICD10CM | Severe sepsis with septic shock |
| T78.2 | ICD10CM | Anaphylactic shock, unspecified |
| T78.2xxA | ICD10CM | Anaphylactic shock, unspecified, initial encounter |
| T81.12 | ICD10CM | Postprocedural septic shock |
| T81.12xA | ICD10CM | Postprocedural septic shock, initial encounter |
ICD code information from First Databank (FDB).
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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