Parenteral Manual

Vasopressin

Disclaimer: Official controlled document is the CHEO 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): 
PITRESSIN®, PRESSYN®
Classification: 
Pituitary hormone- Antidiuretic agent
Original Date: 
August 2005
Revised Date: 
November 2024
Indications: 
  • Diagnosis and treatment of diabetes insipidus
  • Adjunct in the treatment of GI hemorrhage and esophageal varices
  • Treatment of vasodilatory shock with hypotension unresponsive to fluid resuscitation or exogenous catecholamines
Reconstitution and Stability: 
  • Available as a 20 units/mL solution
  • Stable at room temperature
  • Vial labeled as IM/SC use  -can also be given IV
  • Diluted solutions should be used within 24 hours

Vasopressin 0.02 units/mL:

  • Draw up 5.6 units (0.28 mL) of vasopressin 20 units/mL and add to 250 mL bag of NS or D5W. Draw into 50 mL syringe for use on syringe pump. Note: due to overfill, calculations based on 280 mL

Vasopressin 0.4 units/mL: 

  • Draw up 20 units (1 mL) of vasopressin 20 units/mL and add to 49 mL of NS

Vasopressin 1 units/mL:

  • Draw up 50 units (2.5 mL) of vasopressin 20 units/mL and add to 47.5 mL of NS

 

Compatibility: 

- Solutions Compatible: D5W, NS

- Y-site compatible: ciprofloxacin, dopamine, fluconazole, imipenem/cilastatin, insulin, metronidazole, norepinephrine, phenytoin, piperacillin/tazobactam (tazocin)

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES
IM YES
IV Direct NO
IV Intermittent Infusion NO
IV Continuous Infusion

YES
Dilution for GI Bleed : 1 unit/mL
Dilution for Diabetes Insipidus and for Shock: 0.02, 0.4 and 1 unit/mL

For Diabetes Insipidus dosing less than 0.001 units/kg/hr - use 0.02 units/mL

Click here to access SDC Drug Infusion Sheet

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:  IV continuous infusion

Indication

Initial Dose
Units/kg/HOUR

 Initial Dose
**NOTE DIFFERENT UNITS**
Units/kg/MINUTE		 Maximum Effect
Diabetes
Insipidus		 0.0005   0.01
units/kg/HOUR		 Antidiuresis
Vasodilatory
Shock		   0.0003 - 0.002   Antidiuresis &
Vasoconstriction
(predominantly
peripheral
GI
Hemmorrhage		  

0.002-0.005

Titrate dose prn. If
bleeding stops for 12 hours,
then taper off over 24-48 hours

 0.01
units/kg/MINUTE		 Antidiuresis &
Vasoconstriction
(periperal and
central)

Adult:  IV continuous infusion

Indication Initial Dose Notes Maximum Effect
Diabetes
Insipidus		 0.0005
units/kg/HOUR		 Titrate as required 0.01
units/kg/HOUR		 Antidiuresis
Vasodilatory
Shock		 0.01 - 0.1
units/MINUTE

Titrate to effect

Rates>0.05 units/minute
have been associated
with increased risk of
cardiac arrest in some
patients

   Antidiuresis &
Vasoconstriction
(predominantly
peripheral
GI
Hemmorrhage		 0.2 - 0.4
units/MINUTE		 Titrate dose as required
If bleeding stops for 12
hours, then taper off over 24 - 48 hours.		 0.9
units/MINUTE		 Antidiuresis &
Vasoconstriction
(periperal and
central)

 

Potential hazards of parenteral administration: 
Dosing Range Monitoring

Diabetes Insipidus

(0.0005 to 0.01
units/kg/HOUR

Side effects:

  • Abdominal cramps, nausea,vomiting
  • Hyponatremia with water retention
  • Water intoxication -watch for early signs of drowsiness,
    listlessness and headaches
  • Hypersensitivity reactions (urticaria, bronchoconstriction,
    anaphylaxis have been reported)
  • Tissue necrosis due to extravasation into subcutaneous tissues. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.

Parameters:

  • Serum electrolytes especially Na
  • Serum and urine osmolality
  • Urine output, total fluid intake/output
  • Peripheral edema

Also monitor parameters listed below when at higher doses within this dosing range

Vasodilatory
Shock and
GI
Hemmorrhage

(greater than 0.0003
units/kg/MINUTE)

SAME ONES LISTED ABOVE, PLUS:

Side Effects:

  • Hypertension, bradycardia, vasoconstriction
  • Decreased cerebral,coronary,hepatic,mesenteric,pulmonary,
    and renal blood flow -e.g. arrhythmias, angina, bowel ischemia,
    distal limb ischemia
  • Hypercoagulation - e.g. venous thrombosis

Parameters:

  • Blood pressure, heart rate
  • Renal perfusion:  serum creatinine, BUN
  • Peripheral perfusion: body temperature, capillary refill, peripheral
    pulses, skin pallor: serum lactate
  • Hepatic markers: transaminases, bilirubin
  • Platelet count: hemoglobin and hematocrit
Notes: 
  • Monitor for sudden changes in BP, HR, urine output and fluid intake/output, serum sodium; hemoglobin and hematocrit (GI bleeding)
  • Tachyphylaxis may develop with repeated doses       
  • Use with caution in patients with asthma, seizure disorders, vascular disease, renal disease, cardiac disease      
  • If repeated doses are given SC or IM, vary the injection site to avoid severe inflammatory reaction
  • Special attention should be given to IV site to avoid or detect extravasation at an early stage
  • Abrupt discontinuation of infusion may result in hypotension; to discontinue gradually taper infusion
  • IM/SC:
    - Onset of action: 1 hour
    - Duration of action: 2-8 hours

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