Dosage and Administration
General
- May administer 1–2 glasses of water with vasopressin to reduce occurrence of adverse effects (e.g., skin blanching, abdominal cramps, nausea) and improve therapeutic response.
Administration
Administer IM or sub-Q.
May administer topically to nasal mucosa for antidiuresis; do not inhale.
May administer IV† (e.g., for ACLS during CPR, GI hemorrhage), by intraosseous injection† (e.g., for ACLS during CPR) or intra-arterially (e.g., for GI hemorrhage). Although vasopressin may be administered via an endotracheal tube† for ACLS during CPR, a specific dose is not established and IV† or intraosseous† administration is preferred because of more predictable drug delivery and pharmacologic effect.
IM or Sub-Q Administration
Usually, administer IM or sub-Q at 3- to 4-hour intervals as needed.
Intranasally
May be applied topically to the nasal mucosa as a spray, drops, or via a saturated pledget; the drug should not be inhaled.
IV or Intra-arterial Administration
May administer by IV injection† for ACLS during CPR.
May administer by continuous IV† or intra-arterial† infusion (e.g., for GI hemorrhage†).
GI hemorrhage, particularly alcoholic cirrhotics: Preferably, administer initially by continuous IV infusion, since intra-arterial infusion is not more effective but is technically more difficult; patients who fail to respond adequately to initial IV infusion therapy may respond to intra-arterial infusion therapy.
GI hemorrhage: Perform intra-arterial† or IV† administration only under the supervision of a clinician familiar with the pharmacologic effects of vasopressin and with all acceptable treatment modalities for GI bleeding.
GI hemorrhage: Intra-arterial† infusion requires specialized techniques, including angiographic placement of the catheter; limit to clinicians familiar with this method of administration and the management of potential complications.
Dilution
GI hemorrhage, intra-arterial or continuous IV infusion: Generally dilute with 0.9% sodium chloride or 5% dextrose injection to a concentration of 0.1–1 unit/mL.
Rate of Administration
GI hemorrhage: Adjust rate to response and tolerance.
GI hemorrhage, IV infusion: Into a peripheral vein via controlled-infusion device; usually, 0.2–0.9 units/minute.
GI hemorrhage, intra-arterial infusion: Usually, into the superior mesenteric artery via controlled-infusion device; usually, 0.1–0.5 units/minute.
GI hemorrhage, intra-arterial infusion: Also into the splenic or celiac axis usually, 0.1–0.5 units/minute.
Diverticular hemorrhage, intra-arterial infusion: Into the inferior mesenteric artery.
Intraosseous Administration
For ACLS during CPR in adults, may administer by intraosseous injection†; onset of action and systemic concentrations are comparable to those achieved with central venous administration.
Dosage
Potency of vasopressin (arginine and lysine) is standardized according to pressor activity in rats and is expressed in USP posterior pituitary (pressor) units.
Antidiuretic activity of commercially available preparations may be variable.
Antidiuretic dosages are variable and must be adjusted according to response; to avoid adverse effects, it is desirable to give doses that are just sufficient to elicit the desired response.
Adults: 10 units elicit full physiologic response; 5 units adequate in many cases.
Pediatric Patients
Diabetes Insipidus
Neurohypophyseal
IM or Sub-Q
2.5–10 units 2–4 times daily.
Intranasal
Individualize dosage and dosing interval according to response.
Abdominal Distention and Abdominal Radiographic Procedures
IM
Give doses proportionately reduced from adult dose.
Diagnostic Uses
Provocative Testing for Growth Hormone and Corticotropin Release
IM
0.3 units/kg; then obtain blood specimens and assay for hormones.
Adults
Diabetes Insipidus
Neurohypophyseal
IM or Subcutaneous
5–10 units 2–4 times daily as needed; range 5–60 units daily.
Intranasal
Individualize dosage and dosing interval according to response.
CPR (Cardiac Arrest)
VF, Pulseless VT, Pulseless Electrical Activity, and Asystole in ACLS
IV
40 units, given as a single dose, may replace first or second dose of epinephrine.
Intraosseous
40 units, given as a single dose, may replace first or second dose of epinephrine.
Abdominal Distention and Abdominal Radiographic Procedures
Abdominal Distention
IM
Usually, 5 units; may give subsequent doses every 3–4 hours, increasing to 10 units if necessary.
Dosage applies to prevention and relief of postoperative distention and other causes.
Abdominal Radiographic Procedures
Sub-Q
5–15 units given 2 hours and repeated 30 minutes prior to abdominal radiographs and kidney biopsy (before films are exposed); usually give an enema prior to the first dose.
Diagnostic Uses
Provocative Testing for Growth Hormone and Corticotropin Release
IM
10 units; then obtain blood specimens and assay for hormones.
GI Hemorrhage
Esophageal Varices and GI Bleeding
IV Infusion
Dosage is empiric and must be individualized according to response and tolerance.
Because many of the adverse effects are dose related, the lowest possible effective dosage should be used.
Usually initiate at 0.2–0.4 units/minute and progressively increase to 0.9 units/minute if necessary. Additional benefit at higher rates unlikely.
After 24 hours, the infusion rate should be tapered according to patient response, but administration of vasopressin has been continued for 3 days to 2 weeks.
Intra-arterial Infusion
Dosage is empiric and must be individualized according to the response and tolerance.
Because many of the adverse effects are dose related, the lowest possible effective dosage should be used.
Usually, 0.1–0.5 units/minute; after 20–30 minutes, the vasoconstrictive and clotting responses to intra-arterial vasopressin can be assessed by angiography.
Response also can be monitored with portal pressures or hepatic wedge pressures.
After 24 hours, the infusion rate should be tapered according to patient response, but administration of vasopressin has been continued for 3 days to 2 weeks.
Vasodilatory Shock
IV Infusion
Optimum dosage and duration remain to be established; usually, 0.02–0.1 units/minute.
Special Populations
Dosage in Hepatic Impairment
Hepatic Impairment
No specific dosage recommendations for patients with hepatic impairment.
Dosage in Renal Impairment
Renal Impairment
No specific dosage recommendations for patients with renal impairment.
Geriatric Patients
No specific dosage recommendations compared to younger adults.
Print
Email
Drug Info Tools
Medicare's drug plans are subsidized by the US federal government and offered through insurers.
