Vasopressin IV Drip

ANNE ARUNDEL MEDICAL CENTER

CRITICAL CARE MEDICATION MANUAL
DEPARTMENT OF NURSING AND PHARMACY
Guidelines for Use of Intravenous
Vasopressin (Pitressin), Anti-diuretic Hormone (ADH)
Major Indications

Control of gastrointestinal (GI) bleeding due to esophageal varices, peptic ulcers, gastritis
esophago-gastritis, Mallory-Weiss tears, etc. (non FDA approved)
Treatment of diabetes insipidus caused by deficiency of endogenous ADH.
Vasoconstriction for treatment of septic shock (non FDA approved)
Cardiac Arrest (non FDA approved)

Mechanism of Action
Vasopressin exerts an intense vasoconstrictive action on smooth muscle in the
prehepatic splanchnic viscera which reduces the portal pressure and blood flow through
the portal vein.
At lower doses, may increase mean arterial pressure (MAP), systemic vascular
resistance (SVR), cardiac output and urine output.
May also stimulate platelet aggregation via release of Von Willebrands Factor and
Factor VIIIc
Vasopressin, in lower doses, also serves as an exogenous source of ADH.
Pharmacokinetics

IV

Onset of Effect
1-3 minutes

Peak Effects
5-10 minutes

Duration of Effect
10-35 minutes

IM and SQ injection effects may last from 2 to 8 hours

Dosage & Administration
GI Bleeding (unlabeled)
Bolus: Not Recommended (20 units over 20 - 30 minutes has been used with increased
risk of side effects)
Infusion: 0.2 units/min. (12 units/hr) - infuse via large peripheral vein or via central
access.
Titrate based on clinical response: increase by 0.2 units/min (12 units/hr) every 30 60 minutes
up to 1 unit/min. (60 units/hr).
(Higher infusion rates - up to 1.5 units/min, have been used without clearly significant
improvement in patient.)
Once bleeding has been controlled for 12-24 hours, the infusion should be tapered over 12 hours.

Page 1 of 4

Vasopressin revised 8/2011

Vasopressin IV Drip
Septic Shock (unlabeled)
IV continuous infusion at 0.01 to 0.04 units/minute
NOTE: doses > 0.04 units/min have been associated with increased cardiac side effects and do
not considerably improve hemodynamics
Cardiac Arrest (unlabeled)
Single dose of 40 units IV Push
Central Diabetes Insipidus
I.M., SubQ: 5-10 units 2-4 times/day as needed
IV (unlabeled) 2.5 units/hr
Monitoring
Strict input/output
urine specific gravity
Weight
Electrolytes
EKG, Blood pressure
Serum osmolality
Serum sodium
Adverse Effects*
1. Gastrointestinal: abdominal cramps, nausea, vomiting, and diarrhea.
2. Cardiovascular: bradycardia, asystole, PVC, angina, hypertension, fluid overload, chest pain,
and MI.
3. CNS: headache, somnolence, confusion, and vertigo.
4. Miscellaneous: sweating, fluid retention, and hypersensitivity.
*All side effects are dose-related and respond to downward titration of infusion rate.
Drug Interactions:
Enhance Vasopressins ADH effect
Carbamazepine
Tricyclic Antidepressants
Fludrocortisone

Diminish Vasopressins ADH effect

Lithium
Demeclocycline
Epinephrine (high dose)
Heparin
Ethanol
Concomitant use of IV Nitroglycerin has been shown to decrease undesirable cardiac effects of
vasopressin, thus promoting tolerance of vasopressin in higher doses.

Page 2 of 4

Vasopressin revised 8/2011

Vasopressin IV Drip

IV Preparation and Administration

Vasopressin
Infusion
Low Dose
(for
cardiac/septic
shock use)

Single Strength
(for GI use)

Double Strength
(for GI use)

Preparation

Resulting Concentration

Stability

Add 1ml
vasopressin
injection (20
units/ml) to
100ml D5W or
NS
Add 10 ml
vasopressin
injection (20
units/ml) to 500ml
D5W or NS
Add 20 ml
vasopressin
injection (20
units/ml) to 500ml
D5W or NS

20 units/100ml
0.2 units/ml

24 hours
Room temperature

200 units/500ml
0.4 units/ml

24 hours
Room temperature

400 units/500ml
0.8 units/ml

24 hours
Room temperature

Vasopressin Infusion Chart

For cardiac, septic shock indications
(0.2units/ml)
Vasopressin
DOSE (Units/min)
0.01
0.02
0.03
0.04
0.05
0.06

Page 3 of 4

Vasopressin DOSE
(units/hr)
0.6
1.2
1.8
2.4
3
3.6

Vasopressin (0.2units/ml)
INFUSION RATE (ml/hr)
3
6
9
12
15
18

Vasopressin revised 8/2011

Vasopressin IV Drip

Vasopressin Infusion Dosage Chart

For GI indications (GI bleed, Esophageal Varices, etc)
Vasopressin
DOSE
Units/Minute
Units/Hour

0.05
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1

3
6
12
18
24
30
36
42
48
54
60

Vasopressin
INFUSION RATE
SINGLE STRENGTH
DOUBLE
(0.4 units/ml)
STRENGTH
Infusion Rate (ml/hr)
(0.8 units/ml)
Infusion Rate (ml/hr)
7.5
3.75
15
7.5
30
15
45
22.5
60
30
75
37.5
90
45
105
52.5
120
60
135
67.5
150
75

Notes/ Comments:
1. Double strength solution should only be used when high doses are needed in fluid restricted
patients.
2. Vasopressin is compatible with D5W, NS, verapamil, and lidocaine. It is incompatible with
magnesium solutions and no data is available on the compatibility with potassium salts.
3. Usual dosage range 0.1 units/min to 0.9 units/min.
4. If glass ampules are used, use a filter needle during preparation
5. Tissue necrosis occurs with extravasation. Infusion via central line and infusion pump
device is recommended.
References:
1. Lexi-Comp, Inc. (2011) retrieved from http://www.uptodate.com August 2011.
2. Elsevier/Gold Standard (2011). Retrieved from http://www.clinicalpharmacology-ip.com
August 2011.
3. Martin, G. (2008). Vasopressin vs. norepinephrine in patients with septic shock. NEJM 358,
877-887.
4. Delmas Anne, Leone Marc, Rousseau Sebastien, et al. (2005). Clinical Review: Vasopressin
and terlipressin in septic shock patients. Critical Care, 9, 212-222.
5. McAuley David F. (2011).What are the current recommendations regarding the use of
vasopressin in the treatment of shock? Retrieved from http://www.globalrph.com August 2011.

Page 4 of 4

Vasopressin revised 8/2011