VASOPRESSIN IN DEXTROSE 5%

Clinical safety rating: safe

Other drugs that can cause water intoxication may have additive effects Can cause hyponatremia and tissue necrosis with extravasation.

How it works

Vasopressin binds to V1a receptors on vascular smooth muscle, causing vasoconstriction; binds to V2 receptors in renal collecting ducts, increasing water reabsorption.

What the body does with it

Metabolism	Primarily metabolized by the liver and kidneys via peptidases; not significantly metabolized by CYP enzymes.
Excretion	Minimal renal elimination; primarily hepatorenal clearance with extensive extrarenal metabolism; <5% excreted unchanged in urine.
Half-life	10–35 minutes; terminal half-life approximately 15 minutes; clinically short half-life necessitates continuous IV infusion.
Protein binding	Approximately 30–50%; bound primarily to albumin; binding is not concentration-dependent.
Volume of Distribution	0.1–0.3 L/kg; low Vd consistent with limited distribution primarily in plasma volume; reflects minimal tissue penetration.
Bioavailability	Not available for oral route; IV: 100%; extensive first-pass metabolism precludes oral administration.
Onset of Action	IV: Rapid, within 1–2 minutes; onset of vasoconstrictor effect is immediate upon IV administration.
Duration of Action	IV: 30–60 minutes; antidiuretic effect lasts up to 2–8 hours at higher doses; vasopressor effect duration is shorter due to rapid metabolism.

Classification & Brands

Dosing & administration

IV: Initial 0.01–0.04 units/min, titrate by 0.005 units/min every 10–15 min to target effect; max 0.1 units/min. Usual maintenance 0.01–0.06 units/min.

Dosage form	SOLUTION
Renal impairment	No specific GFR-based dose adjustment defined; use caution in severe renal impairment (CrCl <30 mL/min) due to fluid overload risk from dextrose.
Liver impairment	No formal Child-Pugh based modification; vasopressin may increase portal pressure. Use with caution in Child-Pugh C cirrhosis.
Pediatric use	Weight-based: IV 0.0003–0.002 units/kg/min; titrate to effect. Max 0.002 units/kg/min. Alternatively: bolus 0.002–0.01 units/kg/dose for pulseless arrest.
Geriatric use	Start at lower end of dosing range (0.01 units/min); monitor for hyponatremia and cardiac ischemia due to increased sensitivity.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Other drugs that can cause water intoxication may have additive effects Can cause hyponatremia and tissue necrosis with extravasation.

FDA category	Animal
Breastfeeding	Not known if excreted in human milk. M/P ratio not available. Due to short half-life and low oral bioavailability, infant exposure is unlikely. Use with caution in nursing mothers.
Teratogenic Risk	Vasopressin is a posterior pituitary hormone. Limited data in human pregnancy. Animal studies show no teratogenic effects at therapeutic doses. Risk cannot be excluded; consider benefit-risk. First trimester: theoretical risk of uteroplacental ischemia; use only if clearly needed. Second/third trimesters: may induce uterine contractions; avoid at term. Category C (US FDA).

Warnings & precautions

■ FDA Black Box Warning

None.

Side Effect Profile

Common Effects	vasodilatory shock
Serious Effects

Absolute Contraindications

["Hypersensitivity to vasopressin","Chronic nephritis with elevated BUN","Severe coronary artery disease","Uncontrolled hypertension"]

Clinical Precautions

Precautions

["Use with caution in patients with coronary artery disease","May cause severe hyponatremia due to antidiuretic effect","Monitor fluid and electrolyte status","May cause ischemia in peripheral, mesenteric, or coronary vascular beds","Extravasation risk"]

Clinical Tips & Counseling

Drug interactions

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VASOPRESSIN IN DEXTROSE 5%

Clinical safety rating: safe

Other drugs that can cause water intoxication may have additive effects Can cause hyponatremia and tissue necrosis with extravasation.

How it works

Vasopressin binds to V1a receptors on vascular smooth muscle, causing vasoconstriction; binds to V2 receptors in renal collecting ducts, increasing water reabsorption.

What the body does with it

Metabolism	Primarily metabolized by the liver and kidneys via peptidases; not significantly metabolized by CYP enzymes.
Excretion	Minimal renal elimination; primarily hepatorenal clearance with extensive extrarenal metabolism; <5% excreted unchanged in urine.
Half-life	10–35 minutes; terminal half-life approximately 15 minutes; clinically short half-life necessitates continuous IV infusion.
Protein binding	Approximately 30–50%; bound primarily to albumin; binding is not concentration-dependent.
Volume of Distribution	0.1–0.3 L/kg; low Vd consistent with limited distribution primarily in plasma volume; reflects minimal tissue penetration.
Bioavailability	Not available for oral route; IV: 100%; extensive first-pass metabolism precludes oral administration.
Onset of Action	IV: Rapid, within 1–2 minutes; onset of vasoconstrictor effect is immediate upon IV administration.
Duration of Action	IV: 30–60 minutes; antidiuretic effect lasts up to 2–8 hours at higher doses; vasopressor effect duration is shorter due to rapid metabolism.

Classification & Brands

Dosing & administration

IV: Initial 0.01–0.04 units/min, titrate by 0.005 units/min every 10–15 min to target effect; max 0.1 units/min. Usual maintenance 0.01–0.06 units/min.

Dosage form	SOLUTION
Renal impairment	No specific GFR-based dose adjustment defined; use caution in severe renal impairment (CrCl <30 mL/min) due to fluid overload risk from dextrose.
Liver impairment	No formal Child-Pugh based modification; vasopressin may increase portal pressure. Use with caution in Child-Pugh C cirrhosis.
Pediatric use	Weight-based: IV 0.0003–0.002 units/kg/min; titrate to effect. Max 0.002 units/kg/min. Alternatively: bolus 0.002–0.01 units/kg/dose for pulseless arrest.
Geriatric use	Start at lower end of dosing range (0.01 units/min); monitor for hyponatremia and cardiac ischemia due to increased sensitivity.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Other drugs that can cause water intoxication may have additive effects Can cause hyponatremia and tissue necrosis with extravasation.

FDA category	Animal
Breastfeeding	Not known if excreted in human milk. M/P ratio not available. Due to short half-life and low oral bioavailability, infant exposure is unlikely. Use with caution in nursing mothers.
Teratogenic Risk	Vasopressin is a posterior pituitary hormone. Limited data in human pregnancy. Animal studies show no teratogenic effects at therapeutic doses. Risk cannot be excluded; consider benefit-risk. First trimester: theoretical risk of uteroplacental ischemia; use only if clearly needed. Second/third trimesters: may induce uterine contractions; avoid at term. Category C (US FDA).

Warnings & precautions

■ FDA Black Box Warning

None.

Side Effect Profile

Common Effects	vasodilatory shock
Serious Effects

Absolute Contraindications

["Hypersensitivity to vasopressin","Chronic nephritis with elevated BUN","Severe coronary artery disease","Uncontrolled hypertension"]