Neonatal Drug Therapy Manual

Vasopressin

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Pressyn
Classification: 
Pituitary hormone - Antidiuretic agent
Original Date: 
February 2011
Revised Date: 
September 2019
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: 
  • 0.00017 - 0.0012 units/kg/min
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 50 mL of 0.9 % NaCl
    • Final concentration: 0.02 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

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