Vasopressin Analogue
Pregnancy: C
Vasopressin (ICU)
Brand names: Pitressin
Adult dose
Dose: 0.03 units/min IV continuous infusion (septic shock adjunct); titrate up to 0.06 units/min
Route: intravenous infusion
Frequency: continuous infusion
Max: 0.06–0.1 units/min
Adjunct to noradrenaline in septic shock — added at noradrenaline ≥0.25 micrograms/kg/min; VASST trial: benefit in less severe shock group
Paediatric dose
Route: IV
Frequency: continuous infusion
Max: 0.01 units/kg/min
Concentration: 20 units/mL (dilute to 0.4 units/mL or 1 unit/mL for infusion) units/min/ml
Vasodilatory shock in children: 0.0003–0.002 units/kg/min; vasopressin-deficient vasodilatory shock post-cardiac surgery in neonates
Dose adjustments
Renal
Use with caution
Hepatic
Use with caution
Clinical pearls
- VASST trial: vasopressin 0.03 units/min + noradrenaline — no overall survival benefit but 10% improved survival in less severe septic shock
- VASST/VANCS: vasopressin reduces AF rate post-cardiac surgery vs. noradrenaline
- Titrate noradrenaline first — vasopressin is additive, not a replacement
Contraindications
- Anuria (anuric renal failure — not for vasopressin-deficient DI)
- Severe coronary artery disease
Side effects
- Digital/mesenteric ischaemia
- Coronary ischaemia
- Hyponatraemia
- Bradycardia
- Skin necrosis (extravasation)
Interactions
- Carbamazepine/chlorpropamide/tricyclics (potentiate antidiuretic effect)
- Lithium/demeclocycline (inhibit antidiuretic effect)
Monitoring
- Blood pressure (continuous)
- Signs of mesenteric ischaemia (lactate)
- Serum sodium
- Cardiac ischaemia signs
Reference: BNFc; BNF 86; VASST trial; Surviving Sepsis Campaign guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.