VASOPRESSIN IN SODIUM CHLORIDE 0.9%
Clinical safety rating: safe
Other drugs that can cause water intoxication may have additive effects Can cause hyponatremia and tissue necrosis with extravasation.
Vasopressin is an antidiuretic hormone that acts on V1 and V2 receptors. V1 receptor activation causes vasoconstriction via phospholipase C and IP3/DAG signaling in vascular smooth muscle. V2 receptor activation in renal collecting ducts increases water permeability via aquaporin-2 insertion, leading to antidiuresis.
| Metabolism | Primarily hepatic and renal metabolism via peptidases; small amount excreted unchanged in urine. |
| Excretion | Primarily renal (approximately 65% of administered dose excreted unchanged in urine); minor biliary/fecal elimination (~5%) |
| Half-life | 10–20 minutes (terminal half-life); clinical context: continuous IV infusion required to maintain steady-state concentrations |
| Protein binding | ~30% bound to plasma proteins (no specific binding proteins identified; binds to V1a and V2 receptors, not carrier proteins) |
| Volume of Distribution | 0.05–0.2 L/kg (confined primarily to extracellular fluid, consistent with water-soluble peptide) |
| Bioavailability | IV: 100% (only route of administration for vasopressin in clinical use; oral and intranasal not applicable) |
| Onset of Action | IV: 5–15 minutes for vasopressor effect |
| Duration of Action | 30–60 minutes (dose-dependent, shorter at higher doses); clinical notes: sustained effect requires continuous infusion |
IV infusion: 0.01–0.04 units/min, titrated to effect; typical septic shock dose: 0.03 units/min. Administered as continuous IV infusion via central line.
| Dosage form | SOLUTION |
| Renal impairment | eGFR < 30 mL/min/1.73 m²: Use with caution; no specific dose adjustment defined. Monitor fluid and electrolyte balance closely. |
| Liver impairment | Child-Pugh Class A/B/C: No specific dose adjustment; however, hepatic insufficiency may impair vasopressin metabolism; monitor for prolonged effect and avoid in severe hepatic dysfunction. |
| Pediatric use | IV infusion: 0.0003–0.002 units/kg/min (0.0003–0.002 U/kg/min); titrate to effect. Maximum dose: 0.002 units/kg/min. Administer via central line. |
| Geriatric use | Initiate at lower end of dosing range (0.01 units/min); titrate cautiously due to increased risk of hyponatremia, fluid overload, and coronary or mesenteric ischemia. Monitor hemodynamics and electrolytes frequently. |
| 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 | Vasopressin is likely excreted into breast milk in small amounts due to its small molecular weight, but no studies provide M/P ratio. Short half-life and oral bioavailability suggests minimal infant exposure; however, caution is advised especially with high maternal doses. |
| Teratogenic Risk |
■ FDA Black Box Warning
None.
| Common Effects | vasodilatory shock |
| Serious Effects |
["Hypersensitivity to vasopressin or any component.","Chronic nephritis with nitrogen retention."]
| Precautions | ["Use caution in patients with cardiovascular disease (risk of myocardial ischemia, arrhythmias).","Monitor fluid/electrolyte balance and urine output.","Risk of severe hyponatremia and seizures.","Extravasation risk—administer via central line for concentrated solutions.","Use caution in elderly and patients with seizure disorders or migraine."] |
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| First trimester: Limited data, but vasopressin is a natural hormone and exogenous administration at high doses may cause uterine contractions and placental hypoperfusion. Second trimester: Risk of decreased placental blood flow and fetal hypoxia. Third trimester: Potential for uterine hypertonicity, fetal distress, and preterm labor. Overall, FDA Pregnancy Category C: Animal studies show adverse effects; no adequate human studies; use only if benefit outweighs risk. |
| Fetal Monitoring | Maternal: Continuous heart rate, blood pressure, fluid balance, and uterine activity monitoring. Fetal: Continuous fetal heart rate monitoring for signs of distress. Assess for hyponatremia, fluid overload, and signs of ischemia (e.g., chest pain, abdominal pain). |
| Fertility Effects | No specific studies; vasopressin is involved in fluid homeostasis. High doses may disrupt normal hormonal balance, but no evidence of direct impairment of fertility in humans. |