Quick summary
Vasopressin (Vasostrict) is an FDA-approved synthetic antidiuretic hormone used as a vasopressor in septic and vasodilatory shock. It raises blood pressure via V1a receptor-mediated vasoconstriction and promotes water reabsorption via V2 renal receptors.
Overview
Vasopressin (Vasostrict) is an FDA-approved synthetic form of the endogenous nonapeptide antidiuretic hormone (ADH) produced by the hypothalamus. It is used intravenously to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluid resuscitation and catecholamines. It also has roles in the management of diabetes insipidus and gastrointestinal variceal bleeding.
Mechanism of action
Vasopressin exerts its vasopressor effects primarily through V1a receptors on vascular smooth muscle. V1a receptor activation is coupled to Gq/11 proteins, stimulating phospholipase C to generate IP3 and diacylglycerol, leading to intracellular calcium release and smooth muscle contraction. This increases peripheral vascular resistance and raises mean arterial pressure without direct cardiac stimulation. In vasodilatory shock (including septic shock), endogenous vasopressin is depleted; exogenous supplementation restores vascular tone and may reduce catecholamine requirements. V2 receptor activation on renal collecting duct cells promotes water reabsorption via aquaporin-2 insertion, mediating the antidiuretic effect. Vasopressin also activates V1b receptors in the anterior pituitary (modulating ACTH release) and oxytocin receptors, and exerts procoagulant activity via factor VIII and von Willebrand factor release.
Dosing protocols
| Purpose | Route | Dosage | Frequency | Notes |
|---|---|---|---|---|
| vasodilatory shock (septic, post-cardiac surgery) | intravenous | 0.01–0.03 units/min | continuous IV infusion, titrate to MAP target | Fixed dose adjunct: 0.03 units/min added to catecholamine. Do not titrate vasopressin in place of titrating norepinephrine. Doses above 0.04 units/min associated with myocardial ischemia and bowel necrosis. |
| diabetes insipidus | intramuscular | 5–10 units | every 8–12 hours as needed | For central DI: 5–10 units IM every 8–12 hours. Monitor serum sodium and urine osmolality. Desmopressin (DDAVP) is usually preferred for chronic DI management. |
Dosing information is for educational purposes only. Consult a qualified healthcare professional before using any peptide.
Research summary
The VASST trial (778 patients with septic shock) compared vasopressin plus norepinephrine to norepinephrine alone and found no difference in 28-day mortality in the overall population, but showed a survival benefit in the less severe septic shock subgroup. FDA approved vasopressin (Vasostrict) in 2014 specifically for vasodilatory shock. The VANISH trial explored vasopressin vs. norepinephrine as first-line therapy in septic shock; vasopressin reduced renal replacement therapy use. Current sepsis guidelines recommend vasopressin as a second-line vasopressor adjunct to norepinephrine.[1][2][3][4][5]
Evidence grading
Each claimed benefit is graded by the strength of available evidence. Grades reflect study quality, not effect size.
Strong = multiple RCTs · Moderate = limited trials or observational · Preliminary = animal or in vitro only · Insufficient = anecdotal or no published data
Side effects
Side effects vary by individual. This is not an exhaustive list. Report unusual symptoms to a healthcare professional.
Common stacks
Peptides commonly paired with Vasopressin for synergistic effects.
Legal status
FDA-approved since 2014 as Vasostrict for vasodilatory shock. Administered by continuous intravenous infusion in an ICU setting with hemodynamic monitoring. Not a controlled substance. Compounded vasopressin preparations are also available from 503B outsourcing facilities.
Sourcing & access
Prescription required
Vasopressin is an FDA-approved prescription medication available through licensed healthcare providers, telehealth platforms, and 503A/503B compounding pharmacies.
Frequently asked questions
Vasopressin (Vasostrict) is FDA-approved for increasing blood pressure in vasodilatory shock, including septic shock and post-cardiac surgery hypotension. It is also used for diabetes insipidus and off-label for GI variceal bleeding.
Vasopressin acts on V1a receptors in vascular smooth muscle to cause vasoconstriction and raise blood pressure without direct cardiac stimulation. In septic shock, endogenous vasopressin is depleted; exogenous supplementation restores vascular tone and may reduce catecholamine requirements.
The standard dose is 0.03 units per minute as a fixed-dose adjunct to norepinephrine. Vasopressin itself is typically not titrated; norepinephrine is titrated to MAP target. Doses above 0.04 units per minute are associated with myocardial ischemia and bowel necrosis.
Major risks include digital and mesenteric ischemia, myocardial ischemia, hyponatremia, bradycardia, and decreased platelet count. These are dose-dependent effects of vasopressin's potent V1a-mediated vasoconstriction, with doses above 0.04 units per minute associated with bowel necrosis and cardiac ischemia. Continuous ICU hemodynamic monitoring is mandatory during infusion, and vasopressin is not titrated in place of norepinephrine.
Research references
- Vasopressin versus norepinephrine infusion in patients with septic shock (VASST Trial)PubMed
- Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical TrialPubMed
- Arginine vasopressin for the treatment of septic shock in adultsPubMed
- Vasopressin or norepinephrine in early hyperdynamic septic shock: a randomized clinical trialPubMed
- Arginine vasopressin in septic shock: supplement or substitute for norepinephrine?PubMed