Vasopressin

Pitressin is indicated for prevention and treatment of postoperative abdominal distention, in abdominal roentgenography to dispel interfering gas shadows, and in diabetes insipidus.

Take vasopressin exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The Vasopressin dose your doctor recommends will be based on the following (use any or all that apply):

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight
• your height
• your age
• your gender

Vasopressin is available in the following doses:

• Vasopressin 20 Units/ml Injectable Solution

Vasopressin is a man-made form of a hormone called "anti-diuretic hormone" that is normally secreted by the pituitary gland. Vasopressin acts on the kidneys and blood vessels.

Vasopressin helps prevent loss of water from the body by reducing urine output and helping the kidneys reabsorb water into the body. Vasopressin also raises blood pressure by narrowing blood vessels.

Vasopressin is used to treat diabetes insipidus, which is caused by a lack of a naturally occurring pituitary hormone in the body. Vasopressin is also used to treat or prevent certain conditions of the stomach after surgery or during abdominal x-rays.

Vasopressin may also be used for purposes not listed in this medication guide.

Avoid drinking alcohol during your treatment with vasopressin. Alcohol can make vasopressin less effective.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers right away if you have:

• chest pain or tight feeling;

• severe or pounding headache, severe drowsiness, feeling very weak;

• slow heart rate, weak pulse, fainting, slow breathing;

• loss of color in your lips or around your mouth;

• numbness or tingling in your hands or feet; or

• pain or loss of feeling anywhere in your body.

Common side effects may include:

• slow heartbeats;

• pale skin, numbness in your fingers or toes;

• stomach pain, gas, nausea, vomiting;

• dizziness, headache;

• sweating; or

• rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Usual Adult Dose for Asystole:

40 units intravenously once, followed by 20 mL of normal saline. If spontaneous circulation is not restored within 3 minutes, another 40 units may be given intravenously. If spontaneous circulation is still not restored, 1 mg of epinephrine maybe given intravenously. All doses should be followed with 20 mL of normal saline.

The use of vasopressin to treat asystole is not approved by the FDA.

Usual Adult Dose for Ventricular Fibrillation:

40 units intravenously once, followed by 20 mL of normal saline. If spontaneous circulation is not restored within 3 minutes, another 40 units may be given intravenously. If spontaneous circulation is still not restored, 1 mg of epinephrine maybe given intravenously. All doses should be followed with 20 mL of normal saline.

The use of vasopressin to treat asystole is not approved by the FDA.

Usual Adult Dose for Ventricular Tachycardia:

40 units intravenously once, followed by 20 mL of normal saline. If spontaneous circulation is not restored within 3 minutes, another 40 units may be given intravenously. If spontaneous circulation is still not restored, 1 mg of epinephrine maybe given intravenously. All doses should be followed with 20 mL of normal saline.

The use of vasopressin to treat asystole is not approved by the FDA.

Usual Adult Dose for Diabetes Insipidus:

5 units to 10 units intramuscularly or subcutaneously 2 to 4 times a day.

Continuous IV infusion: 0.0005 units/kg/hour; double dosage as needed every 30 minutes to a maximum of 0.01 units/kg/hour.

Vasopressin can also be administered intranasally on cotton pledgets, by nasal spray, or by dropper. When vasopressin is administered intranasally by spray or on pledgets, the dosage must be individually titrated for each patient.

Usual Adult Dose for Postoperative Gas Pains:

5 units intramuscularly once.

This dose may be doubled and repeated at three to four hour intervals as needed to prevent or relieve postoperative abdominal distention.

These recommendations apply also to distention complicating pneumonia or other acute toxemias.

Usual Adult Dose for Abdominal Distension Prior to Abdominal X-ray:

10 units intramuscularly once 2 hours prior to X-ray and once again 30 minutes prior to X-ray.

Usual Adult Dose for Gastrointestinal Hemorrhage:

0.2 to 0.4 units/min by continuous intravenous infusion. Then titrate dose as needed (maximum dose: 0.8 units/minute); if bleeding stops, continue at same dose for 12 hours, then taper off over 24 to 48 hours.

Usual Pediatric Dose for Diabetes Insipidus:

2.5 units to 10 units intramuscularly once.

This dose may be repeated 2 to 3 times a day as needed.

Alternatively, a vasopressin infusion at 0.0005 units/kg/hour may be administered and titrated to restrict urine output and maintain a more concentrated urine.

Usual Pediatric Dose for Esophageal Varices with Bleeding:

Continuous IV infusion:
Initial: 0.002-0.005 units/kg/minute; titrate dose as needed; maximum dose: 0.01 units/kg/minute.

Alternative: Initial: 0.1 units/minute; increase by 0.05 units/minute to a maximum of:
less than 5 years: 0.2 units/minute
5 to 12 years: 0.3 units/minute
over 12 years: 0.4 units/minute
If bleeding stops for 12 hours, then taper off over 24 to 48 hours.

Usual Pediatric Dose for Asystole:

Limited data available: 0.4 units/kg IV after traditional resuscitation methods and at least two doses of epinephrine have been administered; Note: Due to insufficient evidence, no formal recommendations for or against the routine use of vasopressin during pediatric cardiac arrest are provided.

Usual Pediatric Dose for Ventricular Fibrillation:

Limited data available: 0.4 units/kg IV after traditional resuscitation methods and at least two doses of epinephrine have been administered; Note: Due to insufficient evidence, no formal recommendations for or against the routine use of vasopressin during pediatric cardiac arrest are provided.

Usual Pediatric Dose for Ventricular Tachycardia:

Limited data available: 0.4 units/kg IV after traditional resuscitation methods and at least two doses of epinephrine have been administered; Note: Due to insufficient evidence, no formal recommendations for or against the routine use of vasopressin during pediatric cardiac arrest are provided.

Anaphylaxis or hypersensitivity to the drug or its components.

Nasal: 3 to 8 hours; IM, SubQ: Antidiuretic: 2 to 8 hours; IV: Vasopressor effect: Within 20 minutes after IV infusion terminated

Half-Life Elimination

IM, IV, SubQ: 10 to 20 minutes (apparent half-life: ≤10 minutes)

Diabetes insipidus: Note: Dosage is highly variable; titrated based on serum and urine sodium and osmolality in addition to fluid balance and urine output. Use of vasopressin is impractical for chronic therapy.

IM, SubQ: 5 to 10 units 2 to 4 times daily as needed

Continuous IV infusion (off-label route): Continuous infusion has not been formally evaluated in the post-neurosurgical adult. However, some convert IM/SubQ requirement to an hourly continuous IV infusion rate.

Vasodilatory shock: IV: Note: Dosage provided is empirical; titrate to lowest dose compatible with an acceptable response.

Post-cardiotomy shock: Initial: 0.03 units per minute. If the target blood pressure response is not achieved, titrate up by 0.005 units per minute at 10- to 15-minute intervals (maximum dose: 0.1 units per minute). After target blood pressure has been maintained for 8 hours without the use of catecholamines, taper by 0.005 units per minute every hour as tolerated to maintain target blood pressure.

Septic shock:

Surviving Sepsis Campaign recommendations: 0.03 units per minute added to norepinephrine to raise MAP to target or to decrease norepinephrine dose. Doses >0.03 units per minute may have more cardiovascular side effects and should only be reserved for salvage therapy (ie, failure to achieve MAP goal with other vasopressors) (SCCM [Dellinger 2013]). If vasopressin is used concurrently with other catecholamines (eg, norepinephrine), patients may experience hypotension if vasopressin is discontinued first (Bauer 2010). To prevent subsequent hypotension after withdrawal of vasopressors, some experts recommend slowly tapering vasopressin (eg, reducing by 0.01 units per minute every 30 minutes) after the catecholamine(s) are discontinued until no longer required.

Manufacturer's labeling: Initial: 0.01 units per minute. If the target blood pressure response is not achieved, titrate up by 0.005 units per minute at 10- to 15-minute intervals. Maximum dose: 0.07 units per minute. After target blood pressure has been maintained for 8 hours without the use of catecholamines, taper by 0.005 units per minute every hour as tolerated to maintain target blood pressure.

Cadaveric organ donation (hormonal resuscitation) (off-label use): IV: Initial: 1 unit bolus followed by a continuous infusion of 0.5 to 4 units/hour administered to the brain-dead donor who is hemodynamically unstable requiring significant vasopressor support; titrate to SVR of 800 to 1200 dynes-sec/cm5; give concomitantly with levothyroxine or liothyronine (preferred), methylprednisolone, and continuous regular insulin infusion (Rosendale 2003a; Rosendale 2003b; Rosengard 2002; Zaroff 2002)

Central diabetes insipidus, post-traumatic (off-label use): IV: Initial: 2.5 units/hour; titrate to adequately reduce urine output (Levitt 1984)

Gastroesophageal variceal hemorrhage (off-label use): Note: Other therapies may be preferred.

Continuous IV infusion: Initial: 0.2 to 0.4 units per minute, may titrate dose as needed to a maximum dose of 0.8 units per minute; maximum duration: 24 hours at highest effective dose continuously (to reduce incidence of adverse effects). Patient should also receive IV nitroglycerin concurrently to prevent myocardial ischemic complications. Monitor closely for signs/symptoms of ischemia (myocardial, peripheral, bowel) (AASLD [Garcia-Tsao 2007]).

There are no dosage adjustments provided in the manufacturer's labeling.

Store intact vials between 2°C and 8°C (36°F and 46°F). Do not freeze.

Vasostrict: May also remove intact vials from refrigeration and store at 20°C to 25°C (68°F to 77°F) for up to 12 months or manufacturer expiration date, whichever is earlier (indicate date of removal on the vial or note the manufacturer expiration date, whichever is earlier). After initial entry into the 10 mL vial, opened vial must be refrigerated; discard 30 days after first puncture. Discard unused diluted solution (in D5W or NS) after 18 hours at room temperature or 24 hours under refrigeration.

Frequency not defined.

Cardiovascular: Angina pectoris, atrial fibrillation, bradycardia, cardiac arrest, cardiac arrhythmia, ischemic heart disease, limb ischemia (distal), localized blanching, low cardiac output, myocardial infarction, right heart failure, shock, vasoconstriction (peripheral)

Central nervous system: Headache (pounding), vertigo

Dermatologic: Circumoral pallor, diaphoresis, gangrene of skin or other tissues, skin lesion (ischemic), urticaria

Endocrine & metabolic: Hyponatremia, hypovolemic shock, water intoxication

Gastrointestinal: Abdominal cramps, flatulence, mesenteric ischemia, nausea, vomiting

Hematologic & oncologic: Decreased platelet count, hemorrhage (intractable)

Hepatic: Increased serum bilirubin

Hypersensitivity: Anaphylaxis

Neuromuscular & skeletal: Tremor

Renal: Renal insufficiency

Respiratory: Bronchoconstriction

5 units to 10 units intramuscularly or subcutaneously 2 to 4 times a day.

Continuous IV infusion: 0.0005 units/kg/hour; double dosage as needed every 30 minutes to a maximum of 0.01 units/kg/hour.

Vasopressin can also be administered intranasally on cotton pledgets, by nasal spray, or by dropper. When vasopressin is administered intranasally by spray or on pledgets, the dosage must be individually titrated for each patient.

Data not available