Neonatal Drug Therapy Manual

Vasopressin

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Updated June 19, 2024 - 3:40pm

Alternate Name(s): 
Pressyn
Classification: 
Pituitary hormone - Antidiuretic agent
Original Date: 
February 2011
Revised Date: 
June 2024
Indications: 
  • Refractory hypotension unresponsive to exogenous catecholamines
  • May be considered for Persistent Pulmonary Hypertension of the Newborn refractory to inhaled Nitric Oxide
Administration: 
  • IV continuous infusion (central line preferred)
Dosage: 
  • Usual dosage range: 0.0003 to 0.002 units/kg/minute
  • Titration Recommendation: titrate by 0.0001 units/kg/minute to maintain BP goal, Q15 minutes1
    1 meant to be general guidance for titrations, use clinical judgment  
Side Effects: 
  • CVS: hypertension, bradycardia, vasoconstriction
  • Endocrine and metabolic: hyponatremia with water retention
  • Hematologic: hypercoagulation -e.g. venous thrombosis
  • Hepatic: splanchnic hypoperfusion is a potential complication
  • Local: tissue necrosis due to extravasation into subcutaneous tissues
  • Renal: decreased urine output, decreased renal perfusion
Parameters to Monitor: 

NOTE: Judicious fluid management and frequent monitoring of electrolytes is required with treatment

  • BP, HR
  • Serum electrolytes especially Na
  • Serum and urine osmolality
  • Urine output, total fluid intake/output
  • Renal perfusion: serum creatinine, BUN
  • Peripheral perfusion: body temperature, capillary refill, peripheral pulses, skin pallor, serum lactate
  • Hepatic markers: transaminases, bilirubin
  • Platelet count, hemoglobin, hematocrit
Reconstitution and Stability: 

CHEO:

  • Vasopressin 20 units/mL
    • Take 0.05 mL (1 unit) and add to 49.95 mL of 0.9 % NaCl
    • Final concentration: 0.02 units/mL
  • Vasopressin 20 units/mL
    • Take 0.4 mL (8 units) and add to 19.6 mL of 0.9% NaCl
    • Final concentration: 0.4 units/mL
  • Vasopressin 20 units/mL
    • Take 1 mL (20 units) and add to 19 mL of 0.9% NaCl
    • Final concentration: 1 unit/mL

​

TOH:

  • Vasopressin 20 units/mL
    • Take 0.05 mL (1 unit) and add to 19.95 mL of D5W
    • Final concentration: 0.05 unit/mL
  • Vasopressin 20 units/mL
    • Take 0.2 mL (4 units) and add to 19.8 mL of D5W
    • Final concentration: 0.2 unit/mL
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Y-site Compatible: dobutamine, dopamine, epinephrine, fluconazole, heparin, insulin, norepinephrine, phenylephrine

Incompatible: furosemide

References: 

- Mohamed A, Nasef N, Shah V, McNamara PJ.  Vasopressin as a Rescue Therapy for Refractory Pulmonary Hypertension in Neonates: Case Series. Pediatr Crit care Med 2014; 15: 148-154

- Bidegain M, Greenberg R, Simmons C, et al.  Vasopressin for Refractory Hypotension in Extremely Low Birth Weight Infants.  J Pediatr 2010; 157: 502-4

- Trissel LA. Handbook on Injectable Drugs. 16th Edition. Bethesda: American Society of Health-System Pharmacists; 2011

- Evidence-based Practice for Improving Quality  (EPIQ) Recommendations on Hemodynamics, 2023

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