Drug updated on 4/17/2024
| Dosage Form | Injection (intravenous; 20 units/mL, 200 units/10 mL [20 units/mL], 20 units/100 mL [0.2 units/mL], 40 units/100 mL [0.4 units/mL], and 60 units/100 mL [0.6 units/mL]) |
| Drug Class | Antidiuretic hormones |
| Ongoing and Completed Studies | ClinicalTrials.gov |
Indication
- Indicated to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines.
Summary
- Vasopressin (Vasostrict) is indicated to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines. It is effective as an adjunct therapy in various circulatory shock conditions, particularly septic shock and cardiac arrest.
- The study summary was derived from five systematic reviews/meta-analyses related to Vasostrict (vasopressin).
- In hospital settings for cardiac arrest cases, the combination of vasopressin and methylprednisolone increases the Return of Spontaneous Circulation compared to placebo. However, no significant difference is observed regarding survival rates post-hospital discharge between groups using this combination and those not.
- For patients suffering from septic shock, vasopressin is a superior adjunct agent to catecholamines like Noradrenaline. It can improve blood pressure more effectively than Dopamine or Dobutamine but may cause digital ischemia at high doses, which necessitates careful dose management.
- As part of a regimen including other agents such as midodrine and fludrocortisone, vasopressin is beneficial for managing clozapine-induced hypotension in critical care situations; however, vigilant monitoring is required due to its potential adverse effects, including severe hypotension when used with adrenaline.
- Compared to norepinephrine and novel agents like angiotensin II (AT_2), selepressin, terlipressin, etc., while treating vasodilatory shocks - although there is a lack of definitive evidence supporting its superiority over others - it does show similar efficacy levels concerning increasing mean arterial pressure but also raises safety concerns about possible thromboembolic events or ischemic incidents requiring further investigation.
Product Monograph / Prescribing Information
| Document Title | Year | Source |
|---|---|---|
| Vasostrict (vasopressin) Prescribing Information. | 2021 | Par Pharmaceutical, Chestnut Ridge, NY |
Systematic Reviews / Meta-Analyses
| Document Title | Year | Source |
|---|---|---|
| The effect of vasopressin and methylprednisolone on return of spontaneous circulation in patients with in-hospital cardiac arrest: a systematic review and meta-analysis of randomized controlled trials. | 2022 | American Journal of Cardiovascular Drugs |
| Efficacy and safety of vasopressin alone or in combination with catecholamines in the treatment of septic shock: a systematic review. | 2022 | Cureus |
| Vasopressin versus norepinephrine as the first-line vasopressor in septic shock: a systematic review and meta-analysis. | 2022 | Journal of Clinical and Translational Research |
| Treatment strategies for clozapine-induced hypotension: a systematic review. | 2022 | Therapeutic Advances in Psychopharmacology |
| Novel vasopressors in the treatment of vasodilatory shock: a systematic review of angiotensin ii, selepressin, and terlipressin. | 2020 | Journal of Intensive Care Medicine |
Clinical Practice Guidelines
| Document Title | Year | Source |
|---|---|---|
| Canadian Critical Care Society clinical practice guideline: the use of vasopressin and vasopressin analogues in critically ill adults with distributive shock. | 2020 | Canadian Journal of Anaesthesia |