Vasopressin

Cyclic Nonapeptide / Antidiuretic Hormone (ADH)Rx: PrescriptionCompound: Approved

Also known as: ADH, Antidiuretic Hormone, Arginine Vasopressin, AVP, Pitressin, Vasostrict

Educational Only — Not medical advice. Consult a qualified clinician before using any peptide.

Summary

Vasopressin (arginine vasopressin, AVP) is an endogenous cyclic nonapeptide hormone synthesized in the hypothalamus. Synthetic forms are used clinically for vasodilatory shock (septic shock), cardiac arrest, diabetes insipidus, and esophageal variceal bleeding. It raises blood pressure through vasoconstriction and reduces urine output by promoting renal water reabsorption.

Mechanism of Action

Binds V1a receptors on vascular smooth muscle causing vasoconstriction; binds V2 receptors in renal collecting ducts increasing water reabsorption via aquaporin-2 insertion; binds V1b receptors in pituitary modulating ACTH release.

Routes of Administration

IntranasalIntravenousSubcutaneous

Goals & Uses

  • Cardiac arrest resuscitationEmergency MedicineModerate
  • Control of esophageal variceal bleedingGastroenterologyModerate
  • Treatment of distributive/vasodilatory shockHemodynamic SupportHigh
  • Management of central diabetes insipidusEndocrinologyHigh
  • Postoperative hypotension (vasoplegic syndrome)Perioperative CareModerate

Contraindications

  • Known hypersensitivity to vasopressin or excipientsAllergy/ImmunologyHigh
  • Severe coronary artery disease (relative)CardiovascularModerate
  • Chronic nephritis with nitrogen retentionRenalHigh
  • HyponatremiaElectrolyte/MetabolicModerate

Adverse Effects

  • Headache / pallor / sweatingNeurological/SystemicCommon
  • HypertensionCardiovascularCommonHigh blood pressure
  • Hyponatremia / water intoxicationMetabolicUncommon
  • Nausea, vomiting, abdominal crampingGastrointestinalCommon
  • Myocardial ischemia / anginaCardiovascularUncommon
  • Peripheral ischemia / digital necrosisVascularUncommon

Drug Interactions

  • Indomethacin / NSAIDsModerate
  • Tricyclic antidepressants (e.g., clomipramine)Moderate
  • LithiumModerate
  • Catecholamines (norepinephrine, epinephrine)Moderate

Population Constraints

  • PregnancyReproductive SafetyRelative
  • Patients with heart failureCardiovascularRelative
  • Pediatric patientsAgeRelative
  • Elderly patientsAgeRelative

Regulatory Status

  • European UnionApprovedApproved: Diabetes insipidus, Vasodilatory shockAvailable in various EU member states under different brand names; regulatory status may vary by country.
  • United StatesApprovedApproved: Distributive shock (vasodilatory shock) — to increase blood pressure, Diabetes insipidus (central), Prevention and treatment of postoperative abdominal distensionVasostrict (Par Pharmaceutical) is the branded formulation approved for vasodilatory shock. Generic vasopressin injection also available.
  • United KingdomApprovedApproved: Pituitary-origin diabetes insipidus, Vasopressor support in shockAvailable via MHRA-approved products; desmopressin preferred for chronic DI management.

FDA-approved in the US for distributive shock and other indications. Available as Vasostrict (vasopressin injection). Also used off-label in cardiac arrest per ACLS protocols historically, though removed from most current guidelines.

Evidence & Sources

No sources recorded yet.

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