Cautions
Contraindications
- Chronic nephritis accompanied by nitrogen retention, until reasonable nitrogen concentrations are attained.
- History of anaphylaxis or other hypersensitivity to vasopressin of any component in the formulation.
Warnings/Precautions
Warnings
Diseases in Which Rapid Addition to Extracellular Fluids May Be Hazardous
Use cautiously in patients with seizure disorders, migraine, asthma, heart failure, vascular disease (especially of the coronary arteries), angina pectoris, coronary thrombosis, renal disease, goiter with cardiac complications, arteriosclerosis, or any other disease in which rapid addition to extracellular fluids may be hazardous.
Sensitivity Reactions
Hypersensitivity
Hypersensitivity reactions characterized by urticaria, angioedema, bronchoconstriction, fever, rash, wheezing, dyspnea, circulatory collapse, cardiac arrest, and anaphylaxis.
Appropriate agents for the treatment of hypersensitivity reactions should be readily available.
Major Toxicities
Water Intoxication
May produce water intoxication.
Observe closley for signs of possible development (see Monitoring under Cautions) to prevent ensuing seizures, coma, and death.
Water intoxication may be treated with water restriction and temporary withdrawal of vasopressin until polyuria occurs.
Severe water intoxication may require osmotic diuresis (e.g., with mannitol, hypertonic dextrose, or urea alone or with furosemide).
Little danger with small antidiuretic doses of vasopressin to control diabetes insipidus when fluid intake is not excessive.
Hypertonic saline solutions are not indicated unless immediate correction of hyponatremia is required.
Cardiac Effects
In large doses, may produce increased blood pressure, bradycardia, minor arrhythmias, premature atrial contraction, heart block, peripheral vascular constriction or collapse, coronary insufficiency, decreased cardiac output, myocardial ischemia, and myocardial infarction.
Extreme caution, if at all, in patients with vascular disease (especially of the coronary arteries), since even small doses can precipitate angina; AMI risk with large doses.
Coronary vasodilators (e.g., amyl nitrite, nitroglycerin) may be used to treat angina if it occurs.
An ECG should be used to monitor the hormone’s cardiac effects during IV or intra-arterial therapy.
General Precautions
Polyuria
Cautioun in preoperative and postoperative polyuric patients, since vasopressin requirements may be considerably less than normal.
Monitoring
Monitor fluid intake and output closely, especially in comatose or semicomatose patients.
Monitor electrolyte balance periodically.
Perform ECGs periodically during therapy.
Observe for early signs of water intoxication (e.g., drowsiness, listlessness, headache, confusion, anuria, weight gain) in order to prevent ensuing seizures, coma, and death).
Risks of Intra-arterial Administration
Risk of coronary thrombosis, mesenteric infarction, venous thrombosis, infarction and necrosis of the small bowel, and peripheral emboli resulting from intra-arterial catheterization and infusion into the superior mesenteric artery.
Specific Populations
Pregnancy
Category C.
Although doses sufficient for an antidiuretic effect are not likely to produce tonic uterine contractions that could be deleterious to the fetus or threaten the continuation of the pregnancy, use in pregnant women only when clearly needed.
When administered in ACLS, may decrease blood flow to the uterus; however, the woman must be resuscitated for survival of the fetus.
Lactation
Caution if used in nursing women.
Pediatric Use
Children are particularly sensitive to vasopressin's effects (e.g., volume/hydration disturbances); exercise caution.
Safety and efficacy as vasopressor therapy for pediatric advanced life support (PALS) not established; insufficient evidence to make a recommendation for or against routine use during cardiac arrest in pediatric patients.
Geriatric Use
Geriatric patients are particularly sensitive to vasopressin's effects; exercise caution.
Common Adverse Effects
Adverse effects associated with low doses are infrequent and mild, but increase in frequency and severity with high doses.
Common adverse effects include circumoral pallor, sweating, tremor, pounding in the head, abdominal cramps, passage of gas, vertigo, nausea, vomiting, and eructation. In addition, diarrhea, intestinal hyperactivity, and uterine cramps may occur.
Patients can be advised that some of these effects (e.g., blanching of the skin, abdominal cramps, nausea) may be minimized by taking 1 or 2 glasses of water at the time of vasopressin administration.
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