vasopressin (Rx)

Brand and Other Names:Vasostrict, ADH
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

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)

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 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 data for doses >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 hr 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 IM initially; repeated q3-4hr PRN; may be increased to 10 units

Diabetes Insipidus (Off-label)

5-10 units IM/SC q8-12hr

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 PRN

Safety and efficacy not established

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Interactions

Interaction Checker

and vasopressin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (1)

                • methylphenidate transdermal

                  methylphenidate transdermal and vasopressin both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

                Minor (24)

                • amitriptyline

                  amitriptyline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • amoxapine

                  amoxapine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • carbamazepine

                  carbamazepine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • chlorpropamide

                  chlorpropamide increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • clomipramine

                  clomipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • demeclocycline

                  demeclocycline decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

                • desipramine

                  desipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • doxepin

                  doxepin increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • epinephrine

                  epinephrine decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

                • epinephrine racemic

                  epinephrine racemic decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

                • ethanol

                  ethanol decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

                • fludrocortisone

                  fludrocortisone increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • heparin

                  heparin decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

                • imipramine

                  imipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • lithium

                  lithium decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

                • lofepramine

                  lofepramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • maprotiline

                  maprotiline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • mecamylamine

                  mecamylamine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • nortriptyline

                  nortriptyline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • phenformin

                  phenformin increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • protriptyline

                  protriptyline increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • trazodone

                  trazodone increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • trimipramine

                  trimipramine increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

                • urea topical

                  urea topical increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.

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                Adverse Effects

                Frequency Not Defined

                Abdominal cramps

                Allergic reaction

                Angina

                Bronchial constriction

                Circumoral pallor

                Diarrhea

                Nausea

                Pounding in the head

                Sweating

                Tremor

                Uterine contraction

                Vertigo

                Postmarketing Reports

                Reversible diabetes insipidus

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                Warnings

                Contraindications

                Hypersensitivity; multiple dose vial (10 mL) is contraindicated in patients with known allergy or hypersensitivity to 8-L-arginine vasopressin or chlorobutanol; the 1 mL single dose vial does not contain chlorobutanol; contraindicated only in patients with a known allergy or hypersensitivity to 8-L-arginine vasopressin

                Cautions

                With gastrointestinal (GI) bleeding, infusion should be continued for 12-24 hours after bleeding has stopped, and dosage should then be tapered over 24-48 hours

                Continuous infusion should be administered via controlled infusion device

                Use caution in chronic nephritis with nitrogen retention

                Patients may experience reversible diabetes insipidus, manifested by development of polyuria, a dilute urine, and hypernatremia, after cessation of treatment with vasopressin; monitor serum electrolytes, fluid status and urine output after vasopressin discontinuation; some patients may require readministration of vasopressin or administration of desmopressin to correct fluid and electrolyte shifts

                Pre- and postoperative patients with polyuria may occur

                Use caution in patients with seizure, migraine, asthma, heart failure, vascular disease, angina pectoris, coronary thrombosis, renal disease

                Use in pregnant women only when clearly needed

                A decrease in cardiac index may be observed with the use of vasopressin

                Drug interactions overview

                • Use with catecholamines is expected to result in an additive effect on mean arterial blood pressure and other hemodynamic parameters; hemodynamic monitoring is recommended; adjust dose of vasopressin as needed
                • Use with indomethacin may prolong effect of drug on cardiac index and systemic vascular resistance; hemodynamic monitoring is recommended; adjust dose of vasopressin as needed
                • Use with ganglionic blocking agents may increase the effect of Vasostrict® on mean arterial blood pressure. Hemodynamic monitoring is recommended; adjust the dose of vasopressin as needed
                • Use with drugs suspected of causing SIADH (eg, SSRIs, tricyclic antidepressants, haloperidol, chlorpropamide, enalapril, methyldopa, pentamidine, vincristine, cyclophosphamide, ifosfamide, felbamate) may increase pressor effect in addition to antidiuretic effect of drug; hemodynamic monitoring is recommended; adjust dose of vasopressin as needed
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                Pregnancy & Lactation

                Pregnancy

                There are no available data on use in pregnant women to inform a drug associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes; animal reproduction studies not conducted

                Dose may need adjustments during pregnancy and postpartum period due to increased clearance of vasopressin in the second and third trimester

                Therapy may produce tonic uterine contractions that could threaten continuation of pregnancy

                Lactation

                There are no data on presence of vasopressin injection in either human or animal milk, effects on breastfed infant, or on milk production

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Vasoconstrictor without inotropic or chronotopic effects; stimulates smooth muscle in GI tract to cause peristalsis

                Absorption

                Bioavailability: Destroyed by trypsin in GI tract; must be administered parenterally or intranasally

                Onset (antidiuretic activity): IM/SC, 2-8 hr

                Onset (pressor activity) IV, 30-60 min

                Metabolism

                Metabolized in liver and kidney; rapidly removed from plasma

                Elimination

                Half-life: 10-20 min (parenteral)

                Excretion: Urine (5-10%)

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                Administration

                IV Compatibilities

                Additive: Verapamil

                Y-site: Amiodarone, diltiazem, dobutamine, dopamine, epinephrine, heparin, lidocaine, milrinone, nitroglycerin, norepinephrine, phenylephrine, procainamide

                IV Preparation

                Solution should appear clear, colorless, or nearly colorless

                Dilution required for 20 units/mL vial to 0.1-1 unit/mL with NS or D5W before administration

                Fluid restricted: Dilute 5 mL (100 units) in 100-mL IV bag to yield 1 unit/mL

                Not fluid restricted: Dilute 2.5 mL (50 units) in 500-mL IV bag to yield 0.1 unit/mL

                IV Administration

                Administer by continuous IV or intra-arterial infusion via controlled infusion device

                Storage

                Unopened vials or premixed bottles

                • Refrigerate at 2-8°C (36-46°F); do not freeze, OR
                • Controlled room temperature 20-25°C (68-77°F) for 12 months or manufacturer expiration date (whichever is earlier); do not store above 25°C (77°F)

                Opened vials (after first puncture)

                • Once opened, may store for 48 hr
                • Do not store above 25°C (77°F)
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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                vasopressin intravenous
                -
                20 unit/mL vial
                vasopressin intravenous
                -
                20 unit/mL vial
                vasopressin intravenous
                -
                20 unit/mL vial
                Vasostrict intravenous
                -
                20 unit/mL vial
                Vasostrict intravenous
                -
                20 unit/mL vial
                Vasostrict intravenous
                -
                20 unit/mL vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                vasopressin intravenous

                NO MONOGRAPH AVAILABLE AT THIS TIME

                USES: Consult your pharmacist.

                HOW TO USE: Consult your pharmacist.

                SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Consult your pharmacist.

                DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                NOTES: No monograph available at this time.

                MISSED DOSE: Consult your pharmacist.

                STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

                Information last revised July 2016. Copyright(c) 2022 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

                To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                Adding plans allows you to:

                • View the formulary and any restrictions for each plan.
                • Manage and view all your plans together – even plans in different states.
                • Compare formulary status to other drugs in the same class.
                • Access your plan list on any device – mobile or desktop.

                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.