Vasopressin: Blood Pressure Uses, Warnings, Side Effects, Dosage

Generic Name: vasopressin

Brand and Other Names: Vasostrict, antidiuretic hormone (ADH)

Drug Class: Gastrointestinal Agents, Other; Vasopressin-Related; Antidiuretics, Hormone Analog

What is vasopressin, and what is it used for?

Vasopressin, also known as arginine vasopressin or antidiuretic hormone (ADH) is a natural substance primarily synthesized in the hypothalamus in the brain. Vasopressin regulates the body's fluid and electrolyte (osmotic) balance, blood pressure, sodium levels and kidney function. Hypothalamus releases vasopressin when blood’s water content drops resulting in increased solute concentration (hyperosmolarity), or if blood volume is reduced. Vasopressin primarily works by increasing water reabsorption in the kidneys, which is brought back into circulation. Synthetically produced vasopressin is used to increase the blood pressure in adults who are in a state of severely low blood pressure (hypotension) from vasodilatory shock. Vasopressin binds to vasopressin receptors in different tissues and increases the calcium influx into cells activating many cellular mechanisms. Vasopressin effects include:

• Contraction of smooth vessels around blood vessels that constricts the blood vessels and increases vascular resistance and arterial blood pressure
• Increase in the reabsorption of water in the kidneys, reducing urine output and fluid loss, and increasing the blood volume
• Contraction of smooth muscles in the gastrointestinal tract that promotes peristalsis, a series of contractions that move the gastrointestinal contents

Vasopressin is typically administered with intravenous fluids and norepinephrine to restore normal blood pressure in adults in vasodilatory shock. Vasopressin use helps reduce the requirement of norepinephrine which increases the heart rate and its force of contractions, while vasopressin tends to lower heart rate and cardiac output.

Off-label uses of vasopressin include:

• Diabetes insipidus, a condition that causes excessive urination and fluid loss
• Abdominal distention that occurs after certain surgeries
• To dispel shadows in abdominal x-ray (roentgenography)
• Gastrointestinal hemorrhage
• Part of hormone replacement therapy to manage organ recovery in brain-dead donors

Warnings

• Do not use vasopressin in patients with known hypersensitivity to 8-L-arginine vasopressin, any of the components in vasopressin formulation, or chlorobutanol (multiple dose vial only, single dose vial does not contain chlorobutanol).
• Reversible diabetes insipidus may occur after discontinuation of vasopressin. Monitor patient’s urine output, and fluid and electrolyte balance. Some patients may require correction of fluid and electrolyte balance with readministration of vasopressin or administration of desmopressin.
• Vasopressin may reduce heart rate and cardiac output, use with caution in patients with cardiovascular disease.
• Vasopressin may cause water intoxication. Monitor patients for symptoms such as drowsiness, lethargy and headache, and treat promptly to prevent coma and seizures.
• Avoid leakage out of the blood vessel (extravasation) during infusion. Vasopressin can severely constrict blood vessels and lead to localized tissue death (necrosis), as well as in the extremities.
• With gastrointestinal bleeding, vasopressin infusion should be continued for 12-24 hours after bleeding has stopped, and dosage should then be tapered over 24-48 hours.
• Continuous infusion of vasopressin should be administered via controlled infusion device.
• Use vasopressin with caution in patients with: Kidney disease Migraine Seizures Asthma Vascular disease
• Kidney disease
• Migraine
• Seizures
• Asthma
• Vascular disease

SLIDESHOW

What are the side effects of vasopressin?

Common side effects of vasopressin include:

• Hemorrhagic shock
• Decrease in platelets
• Intractable bleeding
• Right heart failure
• Rapid irregular rhythm of atria (atrial fibrillation)
• Slow heart rate (bradycardia)
• Reduced blood flow to the heart muscle (myocardial ischemia)
• Lower limb ischemia
• Abdominal (mesenteric) ischemia
• Ischemic lesions in the skin
• Increased bilirubin levels
• Acute kidney insufficiency
• Low sodium levels (hyponatremia)
• Abdominal cramps
• Diarrhea
• Nausea
• Bronchial constriction
• Paleness around the mouth (circumoral pallor)
• Chest pain (angina)
• Pounding in the head
• Sweating
• Tremor
• Vertigo
• Uterine contraction
• Allergic reaction
• Reversible diabetes insipidus

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Health News

What are the dosages of vasopressin?

Injection Solution for Dilution

• 20 units/mL (3-mL single-dose vial; 10-mL multidose vial); further dilution required /100mL

Injection Solution, Ready-To-Use

• 20 units/100mL (0.2 units/mL)
• 40 units/100mL (0.4 units/mL)
• 60 units/100mL (0.6 units/mL)

Adult:

Vasodilatory Shock

• Indicated to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines
• Titrate to lowest dose compatible with clinically acceptable response
• Postcardiotomy shock (initial dose): 0.03 units/minute intravenous (IV)
• Septic shock (initial dose): 0.01 unit/minute IV
• Titrate up by 0.005 unit/minute at 10- to 15-minute intervals until target blood pressure reached
• Data are limited for doses greater than 0.1 unit/minute for postcardiotomy shock and 0.07 unit/minute for septic shock; adverse reactions expected to increase with higher doses
• After target blood pressure maintained for 8 hours without use of catecholamines, taper vasopressin injection by 0.005 units/minute every hour as tolerated to maintain target blood pressure

Dosage Modifications

• Hepatic or renal impairment: No dosage adjustment provided in prescribing information

Abdominal Distention (Off-label)

• 5 units intramuscular (IM) initially; repeated every 3 to 4 hours as needed; may be increased to 10 units

Diabetes Insipidus (Off-label)

• 5-10 units intramuscular/subcutaneous (IM/SC) every 8 to 12 hours
• Titrate dose on basis of serum sodium, serum osmolality, fluid balance, and urine output

Abdominal Roentgenography (Off-label)

• 10 units (0.5mL) IM/SC 2 hours before procedure, then 10 units IM 30 minutes before procedure
• May give enema prior to first dose of vasopressin

Gastrointestinal Hemorrhage (Off-label)

• 0.2-0.4 unit/min IV initially; may be increased to 0.8 unit/min IV as needed

Pediatric:

• Safety and efficacy not established.

Overdose

• Vasopressin overdose may cause constriction of various blood vessels including peripheral, abdominal and coronary vessels. Vasopressin overdose may also cause gastrointestinal symptoms, muscle cell breakdown (rhabdomyolysis), and life-threatening ventricular heart rhythm disorders such as torsades de pointes.
• Direct effects of vasopressin usually resolve within minutes of discontinuation. Residual symptoms may be treated with supportive and symptomatic care.

What drugs interact with vasopressin?

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Vasopressin has no known severe, serious, or moderate interactions with other drugs.
• Vasopressin has mild interactions with at least 24 different drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

Pregnancy and breastfeeding

• There are no available data on the effects of maternal use of vasopressin during pregnancy, and it is not known if the drug can cause birth defects, miscarriage or adverse maternal or fetal outcomes.
• Vasopressin doses may need to be increased during the second and third trimesters because of increased clearance.
• Vasopressin may cause tonic uterine contractions which may threaten continuation of pregnancy. Use only when clearly needed in pregnant women.
• There is no information on vasopressin effects on human or animal milk production, or the effects on the breastfed infant.

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Summary

Synthetically produced vasopressin is used to increase the blood pressure in adults who are in a state of severely low blood pressure (hypotension) from vasodilatory shock. Common side effects of vasopressin include hemorrhagic shock, decrease in platelets, intractable bleeding, right heart failure, rapid irregular rhythm of atria (atrial fibrillation), slow heart rate (bradycardia), reduced blood flow to the heart muscle (myocardial ischemia), lower limb ischemia, abdominal (mesenteric) ischemia, ischemic lesions in the skin, increased bilirubin levels, acute kidney insufficiency, low sodium levels (hyponatremia), abdominal cramps, diarrhea, nausea, bronchial constriction, and others. Consult your doctor if pregnant or breastfeeding.

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Prevention & Wellness

From

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https://www.rxlist.com/consumer_vasopressin_vasostrict_adh/drugs-condition.htm

https://reference.medscape.com/drug/vasostrict-adh-vasopressin-342073#0

https://www.uptodate.com/contents/vasopressin-drug-information

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https://www.ncbi.nlm.nih.gov/books/NBK526069/