Vasopressin
Classification
Antidiuretic hormone analog
Indications
CCP: Vasodilatory shock
Contraindications
Hypersensitivity to vasopressin or any component
Adult dosages
CCP: Vasodilatory shock
- ≤ 0.03 units/minute IV. Titrate up by 0.005 units/minute at 10- to 15-minute intervals, to a maximum dose of 0.1 unit/minute, if target blood pressure is not reached.
Pediatric Considerations And Dosing
Not recommended.
Mechanism Of Action
Vasopressin stimulates a family of arginine vasopressin (AVP) receptors, oxytocin receptors, and purinergic receptors (Russell 2011). Vasopressin, at therapeutic doses used for vasodilatory shock, stimulates the AVPR1a (or V1) receptor and increases systemic vascular resistance and mean arterial blood pressure; in response to these effects, a decrease in heart rate and cardiac output may be seen.
Pharmocokinetics
- Onset: within 15 minutes
- Duration: for duration of infusion and ~20 minutes after discontinuation
- Half-life: 10-20 minutes
- Excretion: urine
Adverse Effects
Cardiovascular: Atrial fibrillation, bradycardia, ischemic heart disease, limb ischemia (distal), low cardiac output, right heart failure, shock (hemorrhagic)
Dermatologic: Skin lesion (ischemic)
Endocrine & metabolic: Hyponatremia
Gastrointestinal: Mesenteric ischemia
Hematologic & oncologic: Decreased platelet count, hemorrhage (intractable)
Hepatic: Increased serum bilirubin
Renal: Renal insufficiency
Warning And Precautions
Vasopressin is a vesicant. Ensure patency of infusion line and device to prevent extravasation.
Use with caution in cardiovascular disease -- may worsen cardiac output.