Formulary
Vasopressin: Indications, Dosing, Side Effects and Interactions
Vasopressin is an endogenous hormone with a direct antidiuretic effect on the kidney; it is given in the synthetic form of argipressin.
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Vasopressin: Indications, Dosing, Side Effects and Interactions
Vasopressin is an endogenous hormone with a direct antidiuretic effect on the kidney; it is given in the synthetic form of argipressin.
Drug action
Vasopressin is an endogenous hormone with a direct antidiuretic effect on the kidney; it is given in the synthetic form of argipressin.
Indications and dose
**Pituitary diabetes insipidus**
- **Adult** (By Intramuscular Injection, Or By Subcutaneous Injection): 5-20 units every 4 hours, dose expressed as argipressin.
**Initial control of oesophageal variceal bleeding**
- **Adult** (By Intravenous Infusion): 20 units, dose to be administered over 15 minutes, dose expressed as argipressin.
**Adjunct in acute massive haemorrhage of gastrointestinal tract or oesophageal varices (specialist use only) for vasopressin**
- **Child** (By continuous intravenous infusion): (consult local protocol).
Cautions
Asthma; avoid fluid overload; conditions which might be aggravated by water retention; epilepsy; heart failure; hypertension; migraine
Contraindications
Chronic nephritis (until reasonable blood nitrogen concentrations attained); vascular disease (especially disease of coronary arteries) unless extreme caution
Side effects
Frequency not known Abdominal pain; angina pectoris; bronchospasm; cardiac arrest; chest pain; diarrhoea; flatulence; fluid imbalance; gangrene; headache; hyperhidrosis; hypertension; musculoskeletal chest pain; nausea; pallor; peripheral ischaemia; tremor; urticaria; vertigo; vomiting
Interactions
**Severe interactions:**
- Selective Vasopressin V2-Receptor Antagonist (Tolvaptan) Exposure to tolvaptan is significantly increased (200% in AUC; 80% in Cmax) when tolvaptan, a CYP3A4 substrate, is co-administered with...
- Vasopressin receptor antagonists Tolvaptan [CYP3A substrate] Although not studied, voriconazole is likely to significantly increase the plasma concentrations of tolvaptan.
**Other interactions (9):**
- Combinations requiring caution Combinations which can increase the effects of digoxin when co-administered: amiodarone, canagliflozin, daclatasvir, flibanserin, flecainide, prazosin, propafenone,...
- Drugs leading to an increased vasopressin effect.
- The below listed drugs increase the vasopressin effect, leading to reduced renal electrolyte free water excretion and increase the risk of hospital acquired hyponatraemia following inappropriately...
- Co-administration with vasopressin analogues In addition to its renal aquaretic effect, tolvaptan is capable of blocking vascular vasopressin V2 receptors involved in the release of coagulation...
- Therefore, the effect of vasopressin analogues such as desmopressin may be attenuated in patients using such analogues to prevent or control bleeding when co- administered with tolvaptan.
- It is not recommended to administer Jinarc with vasopressin analogues.
Pregnancy
Oxytocic effect in third trimester.
Breast feeding
Not known to be harmful.
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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