vasopressin (Vasostrict, ADH)
Classes: Gastrointestinal Agents, Other; Vasopressin-Related; Antidiuretics, Hormone Analog
Dosing and uses of Vasostrict, ADH (vasopressin)
Adult dosage forms and strengths
injection solution
- 20 units/mL
Abdominal Distention
5 units IM initially; repeated q3-4hr PRN; may be increased to 10 units
Diabetes Insipidus
5-10 units IM/SC q8-12hr
Titrate dose on basis of serum sodium, serum osmolality, fluid balance, and urine output
Abdominal Roentgenography
10 units (0.5mL) IM/SC 2 hours before procedure, then 10 units IM 30 minutes before procedure
May give enema priotr to first dose of vasopressin
Dosage modifications
Hepatic impairment: Lower doses may be required to achieve response
Gastrointestinal Hemorrhage (Off-label)
0.2-0.4 unit/min IV initially; may be increased to 0.8 unit/min IV PRn
Vasodilatory Shock (Off-label)
0.01-0.04 unit/min IV
Pediatric dosage forms and strengths
injection solution
- 20 units/mL
Abdominal Distention
Proportionately reduced adult dosage
Diabetes Insipidus
2.5-10 units IM/SC/intranasally q8-12hr
Continuous IV infusion: 0.0005 unit/kg/hr initially, then double dose q30min to reach desired effect; not to exceed 0.01 unit/kg/hr
Titrate dose on basis of serum sodium, serum osmolality, fluid balance, and urine output
Gastrointestinal Hemorrhage (Off-label)
0.3 units/kg IV; not to exceed 20 units
0.002-0.005 unit/kg/min IV initially; may be increased to 0.01 unit/kg/min IV PRn
If bleeding controlled for 12-24 hr, taper off over 24-36 hr
Vasostrict, ADH (vasopressin) adverse (side) effects
Frequency not defined
Abdominal cramps
Allergic reaction
Angina
Bronchial constriction
Circumoral pallor
Diarrhea
Nausea
Pounding in the head
Sweating
Tremor
Uterine contraction
Vertigo
Warnings
Contraindications
Hypersensitivity
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
Pre- and postoperative patients with polyuria
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
Pregnancy and lactation
Pregnancy category: C
Lactation: Unknown whether drug is distributed into breast milk; use with caution
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.
Pharmacology of Vasostrict, ADH (vasopressin)
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%)
Administration
IV Compatibilities
Additive: VerapamiL
Y-site: Amiodarone, diltiazem, dobutamine, dopamine, epinephrine, heparin, lidocaine, milrinone, nitroglycerin, norepinephrine, phenylephrine, procainamide
IV Preparation
Infusion: Dilute to 0.1-1 unit/mL with NS or D5W
IV/IM Administration
Administered SC or IM or by continuous IV or intra-arterial infusion via controlled infusion device
Storage
Clear, colorless, or nearly colorless solution
Unopened vials
- 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)