Vasopressin is parenteral exogenous antidiuretic hormone (ADH) of the posterior pituitary gland indicated to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines and for prevention and treatment of postoperative abdominal distention, in abdominal roentgenography to dispel interfering gas shadows and in diabetes insipidus. Studies have demonstrated a catecholamine-sparing effect of vasopressin, suggesting early use of vasopressin in combination with norepinephrine may reduce the adrenergic burden associated with traditional vasopressors. Guidelines recommend adding vasopressin to norepinephrine instead of escalating the dose of norepinephrine in patients with septic shock and inadequate mean arterial pressures.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Injectable Administration
-Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Intravenous Administration
Dilution
-The 0.4 unit/mL and 0.6 unit/mL premixed solutions do not require further dilution prior to administration.
-Dilute the concentrated 20 units/mL solution to a concentration of 0.1 or 1 unit/mL in 0.9% Sodium Chloride Injection or 5% Dextrose Injection. A concentration of 1 unit/mL is suggested for patients with fluid restrictions.
-ASHP Recommended Standard Concentrations for Adult Continuous Infusions: 0.2 units/mL or 1 unit/mL for cardiac/vasopressor indications.
-ASHP Recommended Standard Concentrations for Pediatric Continuous Infusions: 0.04 units/mL, 0.2 units/mL, or 1 unit/mL for cardiac/vasopressor indications.
-Storage: Discard unused solution after 18 hours at room temperature or 24 hours under refrigeration.
Continuous IV Infusion
-Administer through a central vein whenever possible; prolonged administration through a peripheral vein may result in extravasation and skin necrosis. If peripheral administration is necessary, use a 20-gauge or larger catheter and assess the site frequently. If extravasation occurs, administer 5 to 10 mg of phentolamine directly to the site.
Intramuscular Administration
-Inject deeply into a large muscle.
-When used for gastrointestinal radiography, consider administering an enema before the first dose of vasopressin.
Subcutaneous Administration
-Inject subcutaneously taking care not to inject intradermally.
-When used for gastrointestinal radiography, consider administering an enema before the first dose of vasopressin.
Other Administration Route(s)
Intraosseous Administration
NOTE: Vasopressin is not FDA-approved for intraosseous administration.
-During cardiopulmonary resuscitation, the same dosage may be given via the intraosseous route if IV access is unsuccessful or not feasible.
Tremor, vertigo, and "pounding" in head have been reported with vasopressin use.
Reversible diabetes insipidus, manifested by the development of polyuria, dilute urine, and hypernatremia, may occur after discontinuation of 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. Water intoxication and hyponatremia can also occur with vasopressin therapy. Early signs of water intoxication include listlessness, drowsiness, and headaches; unrecognized water intoxication may lead to seizures and terminal coma. Treat water intoxication with water restriction and temporary withdrawal of vasopressin until polyuria occurs. Severe water intoxication may require osmotic diuresis with mannitol, hypertonic dextrose, or urea alone or with furosemide.
Local or systemic allergic reactions may occur in hypersensitive patients. Anaphylaxis (anaphylactic shock and/or cardiac arrest) has been observed shortly after vasopressin injection. Urticaria and bronchoconstriction have also been reported with vasopressin use.
Circumoral pallor, arrhythmias, atrial fibrillation, bradycardia, angina, decreased cardiac output, right heart failure, myocardial ischemia, peripheral vasoconstriction, distal limb ischemia, and gangrene have been reported with vasopressin use. Even small doses may precipitate anginal pain in patients with vascular disease; myocardial infarction may occur with larger doses.
Abdominal pain or cramps, nausea, vomiting, and flatulence have been reported with vasopressin use. Mesenteric ischemia has also been reported. Adverse reactions such as abdominal cramps and nausea usually dissipate within a few minutes and may be alleviated by drinking 1 or 2 glasses of water at the time of vasopressin administration.
Hyperhidrosis, urticaria, cutaneous gangrene, and ischemic skin lesions have been reported with vasopressin use.
Hemorrhagic shock, decreased platelets, and intractable bleeding have been reported with vasopressin use.
Increased bilirubin concentrations (hyperbilirubinemia), acute renal insufficiency, and distal limb ischemia have been reported with vasopressin use.
Vasopressin is contraindicated in patients with a known hypersensitivity vasopressin, 8-L-arginine vasopressin, or any of the product components. The Vasostrict 10 mL multi-dose vial contains chlorobutanol and is contraindicated in patients with a known hypersensitivity to chlorobutanol.
Use vasopressin with caution in patients with heart failure or any state in which a rapid addition to extracellular water may produce hazard for an already overburdened system. Vasopressin may also decrease cardiac index. Do not use vasopressin in patients with vascular disease, especially coronary artery disease, except with extreme caution. In such patients, even small doses may precipitate anginal pain, and with larger doses, the possibility of myocardial infarction should be considered.
Vasopressin is contraindicated in patients with chronic nephritis accompanied by nitrogen retention. Do not administer vasopressin to patients with this renal disease until acceptable nitrogen concentrations are attained.
Use vasopressin with caution in patients with a seizure disorder or migraine. A rapid addition to extracellular water may exacerbate these conditions.
Use vasopressin with caution in patients with asthma. A rapid addition to extracellular water may exacerbate this condition.
Use vasopressin during pregnancy only if clearly needed. There are no available data on vasopressin use in pregnant women to inform a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. It is not known if vasopressin can cause fetal harm when administered to pregnant women or if it can affect reproductive capacity. Because of increased clearance of vasopressin in the second and third trimester, the vasopressin dose may need to be increased. Vasopressin may produce tonic uterine contractions that could threaten the continuation of pregnancy.
Use vasopressin with caution when administering to a breast-feeding woman. There are no data on the presence of vasopressin in human milk, the effects on the breast-fed infant, or the effects on milk production.
For the treatment of central diabetes insipidus:
Intramuscular or Subcutaneous dosage:
Adults: 5 to 10 units IM or subcutaneously every 3 to 4 hours for 2 to 3 times daily as needed.
Infants, Children, and Adolescents: 5 to 10 units IM or subcutaneously every 3 to 4 hours for 2 to 3 times daily as needed. Reduce the dose proportionally for pediatric patients.
Intranasal dosage:
Adults: Intranasal dosages (on cotton pledgets or topically as a spray) are determined for each patient individually.
Children and Adolescents: Intranasal dosages (on cotton pledgets or topically as a spray) are determined for each patient individually.
Intravenous dosage (continuous infusion)*:
Adults: 0.0005 units/kg/hour (0.5 milliunits/kg/hour) continuous IV infusion; titrate by 0.0005 units/kg/hour (0.5 milliunits/kg/hour) every 5 to 10 minutes to achieve a urine output of approximately 100 mL/hour. Infusion rates more than 0.01 units/kg/hour (10 milliunits/kg/hour) are rarely required. However, reported doses are variable; weight-based infusion rates ranging from 0.00025 to 0.04 units/kg/hour (0.25 to 40 milliunits/kg/hour) have been recommended and standard infusions of 2.5 units/hour have been used.
Infants, Children, and Adolescents: 0.0005 units/kg/hour (0.5 milliunits/kg/hour) continuous IV infusion; titrate by 0.0005 units/kg/hour (0.5 milliunits/kg/hour) every 5 to 10 minutes until urine output is decreased to less than 2 mL/kg/hour. Infusion rates more than 0.01 units/kg/hour (10 milliunits/kg/hour) are rarely required.
For the treatment of acute variceal bleeding* or nonvariceal upper GI bleeding*:
Intravenous dosage:
Children and Adolescents: 0.3 units/kg (Max: 20 units) IV as a single dose, then 0.002 to 0.005 units/kg/minute continuous IV infusion. May increase the dose up to 0.01 units/kg/minute.
For the treatment of cardiac arrest* including ventricular asystole* and pulseless electrical activity* (PEA) during cardiopulmonary resuscitation* (CPR):
Intravenous or Intraosseous:
Adults: 20 units IV/IO per CPR cycle (Max: 100 units) plus epinephrine IV for up to 5 CPR cycles and methylprednisolone IV once intra-arrest followed by stress-dose hydrocortisone IV beginning 4 hours after resuscitation for in-hospital cardiac arrest (IHCA) requiring vasopressors improved survival to hospital discharge with favorable neurological status vs. epinephrine and placebo and may be considered in IHCA. Vasopressin offers no advantage as a substitute for epinephrine in cardiac arrest.
For the treatment of hypotension in patients with vasodilatory shock (i.e., post-cardiotomy shock, septic shock) or hemorrhagic shock due to trauma* who remain hypotensive despite fluids and catecholamines:
-for the treatment of hypotension in patients with post-cardiotomy shock:
Intravenous dosage:
Adults: 0.03 unit/minute continuous IV infusion, initially; titrate by 0.005 unit/minute every 10 to 15 minutes to clinical response. Max: 0.1 unit/minute. After target blood pressure is maintained for 8 hours without the use of catecholamines, taper by 0.005 unit/minute every hour as tolerated to maintain target blood pressure.
-for the treatment of hypotension in patients with septic shock:
Intravenous dosage:
Adults: 0.01 unit/minute continuous IV infusion, initially; titrate by 0.005 unit/minute every 10 to 15 minutes to clinical response. Max: 0.07 unit/minute. After target blood pressure is maintained for 8 hours without the use of catecholamines, taper by 0.005 unit/minute every hour as tolerated to maintain target blood pressure. Guidelines recommend adding vasopressin to norepinephrine instead of escalating the dose of norepinephrine in patients with inadequate mean arterial pressures at norepinephrine doses of 0.25 to 0.5 mcg/kg/minute.
Infants*, Children*, and Adolescents*: 0.1 to 8 milliunits/kg/minute continuous IV infusion; this dosage range is not well established, based on several case series/reports and retrospective reviews demonstrating increased arterial blood pressure and urine output as well as decreased catecholamine requirements in pediatric shock. However, low dose vasopressin (0.5 to 2 milliunits/kg/minute continuous IV infusion) showed no clinical benefit and a trend towards increased mortality when used for pediatric vasodilatory shock during a randomized, double-blind, placebo-controlled trial (n = 65, age: 3 to 14 years). Septic shock guidelines suggest the addition of vasopressin or further titration of catecholamines in pediatric patients unresponsive to traditional vasopressor therapy.
-for the treatment of hypotension due to hemorrhagic shock associated with trauma*:
Intravenous dosage:
Adults: 4 units IV bolus, followed by 2.4 units/hour for 5 hours.
For postoperative abdominal distention (e.g., ileus):
Intramuscular dosage:
Adults: 5 units IM every 3 to 4 hours as needed. May increase the dose to 10 units if necessary.
For use in gastrointestinal radiography:
Intramuscular or Subcutaneous dosage:
Adults: 10 units IM or subcutaneously for 2 doses at 2.5 and 0.5 hours before film exposure.
Maximum Dosage Limits:
Dependent on the route of administration and indication for therapy.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
*non-FDA-approved indication
Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Acetaminophen; Dextromethorphan; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Acetaminophen; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Acrivastine; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Amitriptyline: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Brompheniramine; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Brompheniramine; Pseudoephedrine; Dextromethorphan: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Carbamazepine: (Minor) Carbamazepine may cause additive hyponatremia or antidiuretic effects when combined with vasopressin, ADH.
Cardiac glycosides: (Moderate) Carefully monitor patients receiving cardiac glycosides and vasopressors concurrently due to the increased risk of arrhythmia.
Cetirizine; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Chlordiazepoxide; Amitriptyline: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Chlorpheniramine; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Citalopram: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as selective serotonin reuptake inhibitors. Use together may increase the pressor and antidiuretic effects of vasopressin.
Clomipramine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Clozapine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing diabetes insipidus, such as clozapine. Use together may decrease the pressor and antidiuretic effects of vasopressin.
Codeine; Guaifenesin; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Corticorelin, Ovine: (Major) The coadministration of corticorelin, ovine and vasopressin, ADH has resulted in a synergistic effect on the secretion of corticotropin, with a less marked synergistic response on cortisol secretion. The concomitant use of corticorelin and vasopressin should be avoided.
Cyclophosphamide: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as cyclophosphamide. Use together may increase the pressor and antidiuretic effects of vasopressin.
Demeclocycline: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing diabetes insipidus, such as demeclocycline. Use together may decrease the pressor and antidiuretic effects of vasopressin.
Desipramine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Desloratadine; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Desmopressin: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like vasopressin, ADH only with careful patient monitoring.
Dexbrompheniramine; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Dexmethylphenidate: (Moderate) Methylphenidate derivatives can potentiate the actions of both exogenous (such as dopamine and epinephrine) and endogenous (such as norepinephrine) vasopressors. It is advisable to monitor cardiac function if these medications are coadministered. Vasopressors include medications such as epinephrine, dopamine, midodrine, and non-prescription medications such as pseudoephedrine and phenylephrine.
Dextromethorphan; Guaifenesin; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Diethylpropion: (Major) Diethylpropion has vasopressor effects. Coadministration with other vasopressors may have the potential for serious cardiac adverse effects such as hypertensive crisis and cardiac arrhythmias.
Digoxin: (Moderate) Carefully monitor patients receiving cardiac glycosides and vasopressors concurrently due to the increased risk of arrhythmia.
Dihydroergotamine: (Contraindicated) Concomitant use of ergotamine with vasopressors is contraindicated as due to the risk for a synergistic increase in blood pressure. Coadministration may also increase the risk for vasospasm which may lead to cerebral or peripheral ischemia.
Dopamine: (Moderate) Monitor blood pressure and carefully adjust doses during concomitant use of dopamine and vasopressin due to the risk for hypertension. Concomitant use is expected to result in an additive effect on mean arterial blood pressure and other hemodynamic parameters.
Doxepin: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Enalapril, Enalaprilat: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as enalapril. Use together may increase the pressor and antidiuretic effects of vasopressin.
Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as enalapril. Use together may increase the pressor and antidiuretic effects of vasopressin.
Ergotamine: (Contraindicated) Concomitant use of ergotamine with vasopressors is contraindicated as due to the risk for a synergistic increase in blood pressure. Coadministration may also increase the risk for vasospasm which may lead to cerebral or peripheral ischemia.
Ergotamine; Caffeine: (Contraindicated) Concomitant use of ergotamine with vasopressors is contraindicated as due to the risk for a synergistic increase in blood pressure. Coadministration may also increase the risk for vasospasm which may lead to cerebral or peripheral ischemia.
Escitalopram: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as selective serotonin reuptake inhibitors. Use together may increase the pressor and antidiuretic effects of vasopressin.
Ethiodized Oil: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Felbamate: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as felbamate. Use together may increase the pressor and antidiuretic effects of vasopressin.
Fexofenadine; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Fludrocortisone: (Minor) Fludrocortisone can enhance the antidiuretic effect of vasopressin.
Fluoxetine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as selective serotonin reuptake inhibitors. Use together may increase the pressor and antidiuretic effects of vasopressin.
Fluvoxamine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as selective serotonin reuptake inhibitors. Use together may increase the pressor and antidiuretic effects of vasopressin.
Foscarnet: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing diabetes insipidus, such as foscarnet. Use together may decrease the pressor and antidiuretic effects of vasopressin.
Furosemide: (Minor) Use of furosemide with vasopressin increases the effect of vasopressin on osmolar clearance and urine flow. Furosemide increases osmolar clearance 4-fold and urine flow 9-fold when coadministered with exogenous vasopressin in healthy subjects.
Guaifenesin; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Haloperidol: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as haloperidol. Use together may increase the pressor and antidiuretic effects of vasopressin.
Heparin: (Minor) Heparin can decrease the antidiuretic response to vasopressin.
Ibuprofen; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Ifosfamide: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as ifosfamide. Use together may increase the pressor and antidiuretic effects of vasopressin.
Imipramine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Indomethacin: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with indomethacin. Use together may prolong the effect of vasopressin on cardiac index and systemic vascular resistance. Indomethacin more than doubles the time to offset for vasopressin's effect on peripheral vascular resistance and cardiac output in healthy subjects.
Iodixanol: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Iohexol: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Iomeprol: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Ionic Contrast Media: (Major) The intravascular injection of a contrast medium should never be made after the administration of vasopressors since they strongly potentiate neurologic effects. Serious neurologic sequelae, including permanent paralysis, have been reported after cerebral arteriography, selective spinal arteriography, and arteriography of vessels supplying the spinal cord.
Iopamidol: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Iopromide: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Ioversol: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Isosulfan Blue: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Ketamine: (Moderate) Closely monitor vital signs when ketamine and vasopressin are coadministered; consider dose adjustment individualized to the patient's clinical situation. Vasopressin may enhance the sympathomimetic effects of ketamine.
Lithium: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing diabetes insipidus, such as lithium. Use together may decrease the pressor and antidiuretic effects of vasopressin.
Loratadine; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Mecamylamine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with ganglionic blocking agents, such as mecamylamine. Use together may increase the effect of vasopressin on mean arterial blood pressure.
Methyldopa: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as methyldopa. Use together may increase the pressor and antidiuretic effects of vasopressin.
Methylergonovine: (Moderate) Monitor for adverse effects if concomitant use of methylergonovine and vasoconstrictors, such as vasopressors, is necessary. Concomitant use may produce a synergistic increase in blood pressure and may also increase the risk for vasospasm which may lead to cerebral or peripheral ischemia.
Methylphenidate Derivatives: (Moderate) Methylphenidate derivatives can potentiate the actions of both exogenous (such as dopamine and epinephrine) and endogenous (such as norepinephrine) vasopressors. It is advisable to monitor cardiac function if these medications are coadministered. Vasopressors include medications such as epinephrine, dopamine, midodrine, and non-prescription medications such as pseudoephedrine and phenylephrine.
Methylphenidate: (Moderate) Methylphenidate derivatives can potentiate the actions of both exogenous (such as dopamine and epinephrine) and endogenous (such as norepinephrine) vasopressors. It is advisable to monitor cardiac function if these medications are coadministered. Vasopressors include medications such as epinephrine, dopamine, midodrine, and non-prescription medications such as pseudoephedrine and phenylephrine.
Naproxen; Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Non-Ionic Contrast Media: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Norepinephrine: (Moderate) Monitor hemodynamics and adjust drug doses as needed when vasopressin and norepinephrine are used concomitantly. Use together is expected to result in an additive effect on mean arterial blood pressure and other hemodynamic parameters.
Nortriptyline: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Olanzapine; Fluoxetine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as selective serotonin reuptake inhibitors. Use together may increase the pressor and antidiuretic effects of vasopressin.
Paroxetine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as selective serotonin reuptake inhibitors. Use together may increase the pressor and antidiuretic effects of vasopressin.
Pentamidine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as pentamidine. Use together may increase the pressor and antidiuretic effects of vasopressin.
Perphenazine; Amitriptyline: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Phendimetrazine: (Major) Phendimetrazine is a phenylalkaline sympathomimetic agent. All sympathomimetics and psychostimulants, including other anorexiants, should be used cautiously or avoided in patients receiving phendimetrazine. The combined use of these agents may have the potential for additive side effects, such as hypertensive crisis or cardiac arrhythmia.
Phentermine: (Major) Because phentermine is a sympathomimetic and anorexic agent (i.e., psychostimulant) it should not be used in combination with other sympathomimetics. The combined use of these agents may have the potential for additive side effects, such as hypertensive crisis or cardiac arrhythmias.
Phentermine; Topiramate: (Major) Because phentermine is a sympathomimetic and anorexic agent (i.e., psychostimulant) it should not be used in combination with other sympathomimetics. The combined use of these agents may have the potential for additive side effects, such as hypertensive crisis or cardiac arrhythmias.
Protriptyline: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Pseudoephedrine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Pseudoephedrine; Triprolidine: (Major) Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Although no data are available, pseudoephedrine should be used cautiously in patients using significant quantities of other sympathomimetics.
Racepinephrine: (Major) Racepinephrine is a sympathomimetic drug with agonist actions at both the alpha and beta receptors. Patients using racepinephrine inhalation are advised to avoid other non-prescription products containing sympathomimetics since additive adverse effects on the cardiovascular and nervous system are possible, some which may be undesirable. Side effects such as nausea, tremor, nervousness, difficulty with sleep, and increased heart rate or blood pressure may be additive. Patients should avoid use of non-prescription decongestants, such as phenylephrine and pseudoephedrine, while using racepinephrine inhalations. Patients should avoid dietary supplements containing ingredients that are reported or claimed to have a stimulant or weight-loss effect, such as ephedrine and ephedra, Ma huang, and phenylpropanolamine.
Selective serotonin reuptake inhibitors: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as selective serotonin reuptake inhibitors. Use together may increase the pressor and antidiuretic effects of vasopressin.
Serdexmethylphenidate; Dexmethylphenidate: (Moderate) Methylphenidate derivatives can potentiate the actions of both exogenous (such as dopamine and epinephrine) and endogenous (such as norepinephrine) vasopressors. It is advisable to monitor cardiac function if these medications are coadministered. Vasopressors include medications such as epinephrine, dopamine, midodrine, and non-prescription medications such as pseudoephedrine and phenylephrine.
Sertraline: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as selective serotonin reuptake inhibitors. Use together may increase the pressor and antidiuretic effects of vasopressin.
Solriamfetol: (Moderate) Monitor blood pressure and heart rate during coadministration of solriamfetol, a norepinephrine and dopamine reuptake inhibitor, and vasopressors. Concurrent use of solriamfetol and other medications that increase blood pressure and/or heart rate may increase the risk of such effects. Coadministration of solriamfetol with other drugs that increase blood pressure or heart rate has not been evaluated.
Tricyclic antidepressants: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Trimipramine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as tricyclic antidepressants. Use together may increase the pressor and antidiuretic effects of vasopressin.
Urea: (Minor) Systemic urea can potentiate the antidiuretic effect of vasopressin, ADH when both drugs are used concurrently. Dosage adjustments may be required.
Vincristine Liposomal: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as vincristine. Use together may increase the pressor and antidiuretic effects of vasopressin.
Vincristine: (Moderate) Monitor hemodynamics and adjust the dose of vasopressin as needed when used concomitantly with drugs suspected of causing syndrome of inappropriate antidiuretic hormone (SIADH), such as vincristine. Use together may increase the pressor and antidiuretic effects of vasopressin.
Vasopressin exerts its antidiuretic effects by increasing the resorption of water at the renal collecting ducts. Subsequently, urinary flow is reduced and urine osmolality is increased, thereby maintaining serum osmolality within an acceptable physiological range. At the cellular level, vasopressin stimulates adenylate cyclase activity. Increased adenylate cyclase activity increases the levels of cyclic adenosine monophosphate (cAMP) in the distal convoluted tubule and the collecting duct, thereby enhancing the permeability of the membrane to free water. Physiologic doses of vasopressin are administered to patients with neurohypophyseal diabetes insipidus to conserve the large amounts of water that are normally lost in the urine. In contrast to desmopressin, vasopressin induces the release of adrenocorticotropic hormone, increases plasma cortisol concentrations, and exhibits vasopressive and contractile action on visceral smooth muscle.
Vasopressin stimulates the contraction of vascular smooth muscle in coronary, splanchnic, GI, pancreatic, skin, and muscular vascular beds. This effect is most prominent in the capillaries, small arterioles, and venules with less effect on the smooth musculature of large veins. Neither adrenergic agents nor vascular denervation prevents the direct effect of vasopressin on smooth muscle contractile elements. This vasoconstrictive property has been used in managing massive GI hemorrhage; however, vasopressin is no longer indicated for this purpose.
Vasopressin is administered parenterally. It does not appear to bind to plasma protein. Vd is 140 mL/kg. Vasopressin is degraded primarily in the liver and kidneys and has a plasma half-life of about 10 to 20 minutes. Metabolites are not expected to retain significant pharmacological activity. Approximately 5% of the dose is excreted unchanged in the urine. At infusion rates used in vasodilatory shock, the clearance of vasopressin is 9 to 25 mL/kg/minute.
Affected cytochrome P450 isoenzymes and drug transporters: none
-Route-Specific Pharmacokinetics
Intravenous Route
Onset of the pressor effect of vasopressin is rapid, peaking within 15 minutes. After infusion discontinuation, pressor effect fades within 20 minutes. At infusion rates used in vasodilatory shock, vasopressin clearance is 9 to 25 mL/kg/minute. Apparent half-life at this concentration is 10 minutes or less.
Intramuscular Route
The duration of antidiuretic effect is variable, but effects are usually maintained for 2 to 8 hours after IM vasopressin administration.
Subcutaneous Route
The duration of antidiuretic effect is variable, but effects are usually maintained for 2 to 8 hours after subcutaneous vasopressin administration.
-Special Populations
Other
Pregnancy
The clearance of exogenous and endogenous vasopressin increases gradually over the course of pregnancy because of a spillover into blood of placental vasopressinase. During the first trimester of pregnancy, vasopressin clearance is only slightly increased. However, by the third trimester, clearance is increased 4-fold and at term up to 5-fold. After delivery, vasopressin clearance returns to preconception baseline within 2 weeks.