II. Indications
-
Vasopressor (and Vasoconstrictor)
- Shock
- Adjunct to other Vasopressors (e.g. Norepinephrine) in refractory Hypotension (especially Septic Shock)
- Bleeding Esophageal Varices
- Cardiac Arrest
- Shock
- Antidiuretic Hormone Replacement
III. Physiology: ADH Related Water Regulation Mechanisms
- See Sodium and Water Homeostasis
- Antidiuretic Hormone (ADH or Arginine Vasopressin) overall effect is to increase renal water reaborption
- ADH is a polypeptide released from the posterior pituitary
- Response to increased plasma osmolality (and increased plasma Sodium concentration, Hypernatremia)
- Response to decreased plasma osmolality (and decreased plasma Sodium concentration, Hyponatremia)
- Decreased ADH secretion
- Free water diuresis
- Increased plasma Sodium concentration (and increased plasma osmolality)
- Direct Sympathetic System effects to increase Blood Pressure
- See Blood Pressure Physiology
- Antidiuretic Hormone (Vasopressin) strongly increases Vasoconstriction and Peripheral Vascular Resistance
- Abnormal Antidiuretic Hormone
- Syndrome Inappropriate ADH Secretion (SIADH)
- Inappropriate ADH release, resulting in water retention despite normal Sodium and water status
- Results in Isovolemic Hypoosmolar Hyponatremia
- Diabetes Insipidus
- Excessive constant water diuresis due lack of pituitary ADH release or lack of renal response
- Nephrogenic Diabetes Insipidus
- Central Diabetes Insipidus
- Syndrome Inappropriate ADH Secretion (SIADH)
IV. Mechanism: Vasopressin
- Receptor Activity
- Exclusively acts at 3 Vasopressin receptors (some on vasculature)
- V1: Vasoconstriction
- V2: Antidiuretic effects
- V3: ACTH release from anterior Pituitary Gland
- Effects
- Increases Systemic Vascular Resistance while still maintaining CNS and cardiac Blood Flow
- Effective, even in severe acidosis
V. Dosing: Adults
-
Diabetes Insipidus
- Vasopressin 5-10 units IM or SQ twice daily to four times daily as needed
-
Septic Shock
- Vasopressin Infusion: 0.01 to 0.04 units/min
- Max dose
- May increase up to 0.06 units/min if Vasopressin is the sole Vasopressor
- Do not exceed 0.04 units/min if combined with other Vasopressors
- Ischemic complications occur at doses above 0.04 to 0.06 ml/min
-
Cardiac Arrest (old ACLS guidelines)
- Vasopressin 40 units IV once (second dose may be given after 3 minutes if if first ineffective)
- Per older guidelines, Vasopressin 40 units IV once was given instead of Epinephrine 1 mg every 3-5 min
-
Bleeding Esophageal Varices
- Vasopressin 0.2 to 0.4 units/min (up to max of 0.8 units/min - very high dose)
VI. Adverse Effects
- Higher doses may be associated with Myocardial Ischemia
- Hyponatremia (and Water Intoxication)
- Tissue necrosis on extravasation
- Safety is not established for peripheral use of Vasopressin
- Vasopressin is typically only recommended for use via Central Line
- Gastrointestinal distress (Abdominal cramping, Nausea, Vomiting, Flatulence)
- Headache
- Sweating
VII. Resources
- Vasopressin Injection Solution (DailyMed)
VIII. References
- (2020) Tarascon Pharmacopeia, accessed 12/28/2020
- Swaminathan and Weingart (2025) Critical Care Mailbag: All Things Vasopressin, EM:Rap, 1/13/2025
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | The predominant form of mammalian antidiuretic hormone. It is a nonapeptide containing an ARGININE at residue 8 and two disulfide-linked cysteines at residues of 1 and 6. Arg-vasopressin is used to treat DIABETES INSIPIDUS or to improve vasomotor tone and BLOOD PRESSURE. |
| Definition (NCI) | This protein is processed from a precursor protein consisting of arginine vasopressin and two associated proteins, neurophysin II and a glycopeptide, copeptin. Arginine vasopressin is a posterior pituitary hormone which is synthesized in the supraoptic nucleus and paraventricular nucleus of the hypothalamus. Along with its carrier protein, neurophysin II, it is packaged into neurosecretory vesicles and transported axonally to the nerve endings in the neurohypophysis where it is either stored or secreted into the bloodstream. It has a direct antidiuretic action on the kidney, and also causes vasoconstriction of the peripheral vessels. This hormone can contract smooth muscle during parturition and lactation. It is also involved in cognition, tolerance, adaptation and complex sexual and maternal behaviour, as well as in the regulation of water excretion and cardiovascular functions. (LocusLink) |
| Definition (CSP) | usual mammalian antidiuretic hormone, it is a cyclic peptide with arginine in position 8 of the chain. |
| Concepts | Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116) |
| MSH | D001127 |
| SnomedCT | 420773001, 421078009, 77671006, 418097000 |
| English | Vasopressin, Arginine, Argipressin (product), Argipressin (substance), Arginine Vasopressin, Arg Vasopressin, Arg-Vasopressin, Cys-Tyr-Phe-Gln-Asn-Cys-Pro-Arg-Gly-NH2, cyclic 1-6 disulfide, Arginine Vasopressin [Chemical/Ingredient], arginine vasopressin, ARGIPRESSIN, argipressin, AVP - Arginine vasopressin, Arginine vasopressin, DDAVP - Arginine vasopressin, Argipressin, Vasopressin, ADH, AVP, Antidiuretic Hormone, Arginine vasopressor (substance), Arginine vasopressor |
| Spanish | arginina vasopresina (sustancia), arginina vasopresina, argipresina, argipresina (producto), argipresina (sustancia), Arginina Vasopresina, Argipresina, Arg-Vasopresina |
| Portuguese | Arginina Vasopressina, Argipressina, Arginina-Vasopressina, Arg-Vasopressina |
| Russian | АРГИНИН-ВАЗОПРЕССИН, АРГИПРЕССИН, ARGIPRESSIN, VAZOPRESSIN, ARGININ, ARGININ-VAZOPRESSIN, ВАЗОПРЕССИН, АРГИНИН |
| Italian | Arginina vasopressina, Argipressina, Arg-vasopressina |
| French | Arg-vasopressine, Argipressine, Arginine vasopressine, Arginine-8 vasopressine |
| Swedish | Argininvasopressin |
| Finnish | Argipressiini |
| Czech | argipresin, arginin vasopresin |
| Japanese | アルギニンバゾプレッシン, アルギプレシン, アルジプレッシン, バソプレッシン(AVP), バソプレシン-アルギニン, バソプレシン(AVP), アルギニンバソプレシン, アルギニン-バソプレシン |
| Croatian | ARGIPRESIN |
| Polish | Argininowazopresyna, Argipresyna, Wazopresyna argininowa |
| Norwegian | Arginin vasopressin, Argipressin |
| German | Argininvasopressin, Argipressin, Vasopressin, Arginin- |
Ontology: Vasopressins (C0042413)
| Definition (MSH) | Antidiuretic hormones released by the NEUROHYPOPHYSIS of all vertebrates (structure varies with species) to regulate water balance and OSMOLARITY. In general, vasopressin is a nonapeptide consisting of a six-amino-acid ring with a cysteine 1 to cysteine 6 disulfide bridge or an octapeptide containing a CYSTINE. All mammals have arginine vasopressin except the pig with a lysine at position 8. Vasopressin, a vasoconstrictor, acts on the KIDNEY COLLECTING DUCTS to increase water reabsorption, increase blood volume and blood pressure. |
| Concepts | Amino Acid, Peptide, or Protein (T116) , Hormone (T125) , Pharmacologic Substance (T121) |
| MSH | D014667 |
| English | Antidiuretic Hormones, beta Hypophamine, beta-Hypophamine, Vasopressins, Vasopressins [Chemical/Ingredient], adh vasopressin, antidiuretic hormone, ADH, adhs, antidiuretic hormones, vasopressin (ADH), vasopressin |
| French | Hormones antidiurétiques, ADH (Antidiurétic hormones), Bêta hypophamine, Hormones anti-diurétiques, Beta hypophamine, Beta-hypophamine, Bêta-hypophamine, Vasopressines |
| Swedish | Vasopressiner |
| Czech | vasopresiny, antidiuretické hormony |
| Finnish | Antidiureettiset hormonit |
| Italian | Ormoni antidiuretici, Beta-ipofamina, Vasopressine |
| Russian | ANTIDIURETICHESKIE GORMONY, BETA-GIPOFAMIN, VAZOPRESSINY, АНТИДИУРЕТИЧЕСКИЕ ГОРМОНЫ, БЕТА-ГИПОФАМИН, ВАЗОПРЕССИНЫ |
| Japanese | 抗利尿ホルモン, バソプレシン, ベータハイポファミン, バソプレッシン, バゾプレシン |
| Croatian | VAZOPRESINI |
| Polish | ADH, Hormon antydiuretyczny, Wazopresyny |
| Norwegian | Antidiuretisk hormon, Vasopressin, ADH |
| Spanish | Pitresina, betahipofamina, Vasopresinas, Hormonas Antidiuréticas |
| Portuguese | Pitresina, beta Hipofamina, Hormônio Antidiurético, Vasopressinas |
| German | Antidiuretische Hormone, Beta-Hypophamin, Vasopressine |
