Pressor hormone · vasodilatory shock
A synthetic copy of arginine vasopressin, the body's antidiuretic hormone. In hospitals it is infused into a vein to increase blood pressure in adults in vasodilatory shock (for example, septic shock or low blood pressure after heart surgery) when fluids and catecholamine drugs like norepinephrine have not been enough.
Vasopressin is a nine-amino-acid peptide hormone that acts on several receptor types. On blood-vessel muscle, V1 receptors activate phospholipase C and release calcium, which narrows the vessels, raises systemic vascular resistance and lifts blood pressure. In the kidney, V2 receptors cut water loss in urine, which is the hormone's everyday job at low concentrations. At pressor levels it also contracts gut smooth muscle through V1 receptors and triggers ACTH and prolactin release through V3 receptors.
In shock, the pressor effect peaks within about 15 minutes and fades within about 20 minutes after the infusion stops, with no evidence of tolerance. It tends to slow the heart rate and lower cardiac output1.
Human trials have mostly compared vasopressin with norepinephrine. In VASST, 778 adults with septic shock already on catecholamines received low-dose vasopressin or norepinephrine; 28-day mortality did not differ significantly (35.4% vs 39.3%). Fewer deaths in less severe shock were a subgroup finding that a heterogeneity test did not confirm2. VANISH, in 409 adults with early septic shock, found no gain in kidney-failure-free days, though fewer patients on vasopressin needed kidney replacement therapy (25.4% vs 35.3%), a secondary outcome3.
In VANCS, a single-center trial of 300 patients with vasoplegic shock after cardiac surgery, the combined rate of death or severe complications was lower with vasopressin (32% vs 49%), as was atrial fibrillation4. The FDA label cites rises in blood pressure seen in 7 studies in septic shock and 8 in shock after heart surgery1.
FDA-approved as Vasostrict (2014) for adults with vasodilatory shock, to increase blood pressure when hypotension persists despite fluids and catecholamines1; several generic and premixed versions have since been approved.
The label lists adverse reactions drawn from published reports: decreased cardiac output, slow heart rate, fast heart rhythms including atrial fibrillation, low blood sodium, and reduced blood flow to the heart, gut, skin, fingers and toes. Other reports include right heart failure, bleeding, low platelets, raised bilirubin and acute kidney problems. It can worsen heart function, and reversible diabetes insipidus (heavy urination, high blood sodium) can follow stopping it. It must not be used by anyone allergic to vasopressin, or to chlorobutanol, a preservative in the multiple-dose vial.
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