Vasopressin
PITRESSIN
What it isEndogenous antidiuretic hormone with V1 vasoconstriction; vasodilatory shock and diabetes insipidus.
Why this oneIt works through a receptor unaffected by acidosis, so it is added when catecholamines are failing.
What limits itDigital and mesenteric ischemia at higher doses. Hyponatremia from V2 antidiuresis.
FDA-approved for
- vasodilatory shock/DI (~2014)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Vasodilatory shock (post-cardiotomy) — increase blood pressure | Adults | 0.03 units/min IV | Titrate up by 0.005 units/min every 10–15 min to target BP | Limited data above 0.1 units/min |
| Vasodilatory shock (septic shock) — increase blood pressure | Adults | 0.01 units/min IV | Titrate up by 0.005 units/min every 10–15 min to target BP | Limited data above 0.07 units/min |
Renal Undefined
Hepatic Undefined
Continuous IV infusion titrated every 10–15 min
Instructions
- Dilute to 0.1 or 1 unit/mL with NS or D5W for IV infusion (premixed bags need no dilution)
- Continuous IV infusion; titrate to lowest effective dose
- After target BP maintained 8 h without catecholamines, taper by 0.005 units/min every hour as tolerated
- Discard diluted solution after 18 h at room temperature or 24 h refrigerated
Cautions
- Can worsen cardiac function (decreased cardiac index)
- Reversible diabetes insipidus after discontinuation — monitor electrolytes, fluid status, urine output
Adverse reactions
- Decreased cardiac output
- Bradycardia
- Tachyarrhythmias
- Hyponatremia
- Ischemia (coronary, mesenteric, skin, digital)
- Mesenteric ischemia
- Distal limb ischemia
Pregnancy No human data; may produce tonic uterine contractions; clearance increases in 2nd/3rd trimester (dose may need increasing)
Lactation No data on presence in milk
NO BOXED WARNINGS
Principal riskDigital and mesenteric ischemia at higher doses
Classes and tags
Clinical profile
Mechanism of action: Vasopressin ballicule
