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Vasopressin

(Vasostrict®)

Vasopressin

Drug updated on 11/4/2024

Dosage FormInjection (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 ClassCarboxilic acids and derivatives
Ongoing and
Completed Studies		ClinicalTrials.gov

Indication

  • Indicated to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines.

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Summary
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  • This summary is based on the review of 12 systematic review(s)/meta-analysis(es). [1-12]
  • Vasoplegic Shock: No significant difference in mortality observed with vasopressin compared to norepinephrine (OR (odds ratio) = 1.60; CI (confidence interval) 0.47-5.50) or placebo; non-significant reduction in hospital stay length with vasopressin.
  • Hemorrhagic Shock: Mortality rates showed no significant difference between those treated with vasopressin receptor agonists and untreated patients (RR (relative risk)= 1.17; CI 0.67-2.08).
  • Septic Shock: No significant difference in 28-day mortality (OR = 1.07; CI 0.80-1.44) or ICU (intensive care unit) mortality (OR = 0.74; CI 0.21-2.67) between vasopressin and norepinephrine, but lower odds of renal replacement therapy (RRT) requirement in vasopressin-treated patients (OR = 0.68; CI 0.47-0.98); early initiation within 6 hours of shock onset reduced RRT use (OR = 0.63; CI 0.44-0.88).
  • Cardiac Surgery-induced Vasoplegic Shock: No significant differences in 30-day mortality, stroke, ventricular arrhythmias, or duration of mechanical ventilation between vasopressin and other pressors; conflicting evidence on acute kidney injury, atrial arrhythmias, duration of vasopressor use, and ICU stay length.
  • Digital Ischemia: Increased risk observed with vasopressin or its analogs (RR = 2.65; CI 1.26-5.56).
  • Hypotension in Septic Shock: Higher incidence of hypotension when vasopressin is withdrawn before norepinephrine (OR = 0.3; CI 0.10-0.86); discontinuing norepinephrine first results in lower hypotension rates compared to discontinuing vasopressin first (OR = 0.35; CI 0.16-0.76).
  • Other Adverse Events: No significant differences in total adverse events, arrhythmia, acute myocardial infarction, cardiac arrest, acute mesenteric ischemia, ICU/hospital length of stay, and mechanical ventilation duration.
  • There is no population type or subgroup information available in the reviewed studies.

Product Monograph / Prescribing Information

Document TitleYearSource
Vasostrict (vasopressin) Prescribing Information.2023Endo, Inc., Malvern, PA

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Vasopressin in vasoplegic shock in surgical patients: systematic review and meta-analysis2023Acta Cirurgica Brasileira
Effects of Vasopressin Receptor Agonists during the Resuscitation of Hemorrhagic Shock: A Systematic Review and Meta-Analysis of Experimental and Clinical Studies2023Journal of Personalized Medicine
Efficacy and Safety of Vasopressin Alone or in Combination With Catecholamines in the Treatment of Septic Shock: A Systematic Review2022Cureus
Vasopressin versus norepinephrine as the first-line vasopressor in septic shock: A systematic review and meta-analysis2022Journal of Clinical and Translational Research
The effect of early vasopressin use on patients with septic shock: A systematic review and meta-analysis2021The American Journal of Emergency Medicine
Vasopressin in vasoplegic shock: A systematic review2020World Journal of Critical Care Medicine
Vasopressors and Inotropes in Acute Myocardial Infarction Related Cardiogenic Shock: A Systematic Review and Meta-Analysis2020Journal of Clinical Medicine
Clinical Efficiency of Vasopressin or Its Analogs in Comparison With Catecholamines Alone on Patients With Septic Shock: A Systematic Review and Meta-Analysis2020Frontiers in Pharmacology
Incidence of Hypotension after Discontinuation of Norepinephrine or Arginine Vasopressin in Patients with Septic Shock: a Systematic Review and Meta-Analysis2020Journal of Korean Medical Science
Safety of peripheral administration of vasopressor medications: A systematic review2020Emergency Medicine Australasia : Ema
Norepinephrine vs Vasopressin: Which Vasopressor Should Be Discontinued First in Septic Shock? A Meta-Analysis2020Shock (augusta, Ga.)
Effects of the discontinuation sequence of norepinephrine and vasopressin on hypotension incidence in patients with septic shock: A meta-analysis2019Heart & Lung : the Journal of Critical Care

Clinical Practice Guidelines

Document TitleYearSource
Canadian Critical Care Society clinical practice guideline: The use of vasopressin and vasopressin analogues in critically ill adults with distributive shock2020Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie