PITRESSIN TANNATE
Clinical safety rating
cautionComprehensive clinical and safety monograph for PITRESSIN TANNATE (PITRESSIN TANNATE).
Comprehensive clinical and safety monograph for PITRESSIN TANNATE (PITRESSIN TANNATE).
Diabetes insipidus (central)Nocturnal enuresis (off-label)Variceal bleeding (off-label)
Pitressin Tannate is a synthetic form of vasopressin (antidiuretic hormone) that acts on V2 receptors in the renal collecting ducts to increase water reabsorption, and on V1 receptors to cause vasoconstriction.
| Metabolism | Metabolized primarily by the liver and kidneys via peptidases, with a half-life of about 10-20 minutes for vasopressin itself; the tannate formulation prolongs absorption. |
| Excretion | Primarily renal: >95% of administered dose excreted unchanged in urine within 24 hours. Biliary/fecal elimination negligible (<5%). |
| Half-life | Terminal elimination half-life approximately 15 minutes (range 10–20 minutes). Clinically, due to rapid clearance, effects are short-lived; continuous infusion or depot formulations are required for sustained effect. |
| Protein binding | Negligible (<1%); mainly bound to plasma proteins primarily vasopressin-binding proteins and albumin, but binding is not clinically significant. |
| Volume of Distribution | Approximately 0.1 L/kg (range 0.08–0.12 L/kg). This low Vd indicates minimal tissue distribution, consistent with its predominant plasma volume confinement and renal clearance. |
| Bioavailability | Intramuscular oil suspension: nearly 100% but with slow release. Subcutaneous: approximately 10–15% due to hydrolysis at injection site. Oral: negligible (<1%) due to enzymatic degradation. |
| Onset of Action | Intramuscular injection of oil suspension: onset within 30 minutes to 1 hour. Subcutaneous injection: onset within 15–30 minutes. |
| Duration of Action | Intramuscular oil suspension: 48–96 hours. Subcutaneous: 2–6 hours. Clinical note: The oil suspension provides prolonged release; duration depends on dose and disease state (e.g., diabetes insipidus). |
| Molecular Weight | 1084.2 |
0.5-1 mL (5-10 units) intramuscularly or subcutaneously every 24-48 hours as needed for diabetes insipidus.
| Dosage form | INJECTABLE |
| Renal impairment | Not significantly renally excreted; no specific dose adjustment recommended based on GFR. |
| Liver impairment | No specific guidelines; use with caution in hepatic impairment due to potential fluid imbalance. |
| Pediatric use | 0.1-0.3 mL (1-3 units) intramuscularly or subcutaneously, with dose adjusted based on response; monitor urine output and serum sodium. |
| Geriatric use | Start at lower end of dosing range (0.5 mL initially) due to increased risk of electrolyte disturbances and comorbid conditions; monitor serum sodium and fluid status closely. |
| 1st trimester | Vasopressin is teratogenic in animal studies at high doses; use only if clearly needed. |
| 2nd trimester | May cause uterine contractions or premature labor; avoid unless absolutely necessary. |
| 3rd trimester | Risk of induced labor or fetal distress; use only for life-threatening indications. |
Clinical note
Comprehensive clinical and safety monograph for PITRESSIN TANNATE (PITRESSIN TANNATE).
| Placental transfer | Vasopressin crosses the placenta, but extent is not well quantified in humans; animal studies show transfer. |
| Breastfeeding | Excreted into breast milk in small amounts; unlikely to harm nursing infant, but caution advised due to potential hormonal effects. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | PITRESSIN TANNATE (vasopressin tannate) is classified as FDA Pregnancy Category C. In animal studies, vasopressin has been associated with decreased fetal weight and delayed ossification at high doses. There are no adequate and well-controlled studies in pregnant women. The drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Vasopressin may cause uterine contractions and decrease placental perfusion, potentially leading to fetal hypoxia or distress, particularly in the third trimester. |
| Fetal Monitoring | Monitor maternal blood pressure, heart rate, and urine output. Assess for signs of water intoxication (hyponatremia, headache, confusion, seizures). For the fetus, monitor fetal heart rate and uterine activity if administered near term due to potential oxytocin-like effects. In high-risk pregnancies, consider ultrasound for fetal growth and amniotic fluid index. |
| Fertility Effects | Data on fertility effects in humans are lacking. In animal studies, high doses of vasopressin have been associated with altered estrous cycles and reduced fertility. Clinical relevance is uncertain. |
■ FDA Black Box Warning
None.
| Serious Effects |
Hypersensitivity to vasopressinNephrogenic diabetes insipidus (inability to concentrate urine)Chronic renal failure
| Precautions | Hyponatremia and water intoxication; cardiac effects including arrhythmias and ischemia; mesenteric ischemia; hypersensitivity reactions; use with caution in patients with coronary artery disease, hypertension, or renal impairment. |
| Food/Dietary | Avoid excessive fluid intake beyond thirst to prevent water intoxication. Limit alcohol, which can inhibit vasopressin release and reduce drug efficacy. No specific food restrictions. |
| Clinical Pearls | Pitressin Tannate is an aqueous suspension of vasopressin for intramuscular injection used for diabetes insipidus. Must be warmed and shaken vigorously before administration to ensure uniform suspension. Inject deeply IM into a large muscle; do not administer IV or subcutaneously. Onset is within 1-2 hours, duration 24-72 hours. Monitor for signs of water intoxication (headache, confusion, seizures) due to antidiuretic effect. Caution in coronary artery disease, hypertension, and renal impairment. Discontinue if abdominal cramps or nausea occur. Not for use in chronic nephrogenic diabetes insipidus. |
| Patient Advice | This medication is given as an injection into a muscle, usually every 1-3 days as prescribed. · Do not inject into a vein or under the skin; only into a muscle (buttock or thigh). · Warm the vial in your hands and shake it well just before use to mix the suspension evenly. · Drink only enough fluid to satisfy thirst; excessive fluid intake can lead to water intoxication. · Report any signs of water intoxication: severe headache, confusion, drowsiness, seizures, or difficulty breathing. · Avoid alcohol, which can interfere with the drug's effect and increase urine output. · Store the vial at room temperature away from light and do not freeze. · Monitor urine output and notify your doctor if it does not decrease or if side effects occur. |
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