Names and pronunciation
(vay-soe-press′in) Vasostrict
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Drug reference
(vay-soe-press′in) Vasostrict
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Func. class.: Pituitary hormone
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Chem. class.: Lysine vasopressin
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Do not confuse: vasopressin/desmopressin
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ACTION: Promotes the reabsorption of water via action on the renal tubular epithelium; causes vasoconstriction
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USES: Diabetes insipidus (nonneph rogenic/nonpsychogenic), hypotension, shock, septic shock, postcardiotomy car diogenic shock
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Unlabeled uses: Cardiac arrest, bleeding esophageal varies
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CONTRAINDICATIONS: Hyper sensitivity, chronic nephritis Precautions: Pregnancy, breastfeeding, CAD, asthma, vascular/renal disease, migraines, seizures
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SIDE EFFECTS CNS: Headache, lethargy, flushing, vertigo CV: Chest pain, MI GI: Nausea, heartburn, cramps, vomiting, flatus MISC: urticaria
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INTERACTIONS Increase: antidiuretic effect—tricyclics, SSRIs, carBAMazepine, chloropromide, fludrocortisone, clofibrate Decrease: antidiuretic effect—lithium, demeclocycline, chlorpropamide, cyclo phosphamide, enalapril, felbamate, halo peridol, pentamine
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DOSAGE AND ROUTES Diabetes insipidus • Adult: IM/SUBCUT 5-10 units bid-qid as needed; CONT IV INFUSION 0.0005 units/kg/hr (0.5 milliunit/kg/hr), double dose q30min as needed • Child: IM/SUBCUT 2.5-10 units bid- qid as needed Hypotension in septic shock • Adult: IV 0.01 units/min, titrate by 0.005 units/min q10-15min until B/P target is achieved, to max 0.07 units/min after target B/P of 8 hr without use of catecholamines; taper 0.005 units/min q1hr to maintain B/P GI hemorrhage (unlabeled) • Adult: IV 0.2-0.4 units/min, titrate, max 0.8 units/min
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Available forms: Sol for inj 20 units/mL Administer Direct IV route • During adult CPR, resuscitation drugs may be administered intrave nously by bolus injection into a periph eral vein, followed by an injection of 20 mL IV fluid; elevate the extremity for 10-20 sec Continuous IV INFUSION route • Dilute 2.5 or 5 mg/500 mL respectively of 0.9% NaCL or D5W to 0.1 or 1 unit/mL in NS or D5W. 1 unit/mL is suggested for those with fluid restrictions • Discard unused solution after 18 hr at room temperature or 24 hr under refrig eration IM route • Inject deeply into a large muscle; as pirate prior to injection to avoid injec tion into a blood vessel SUBCUT route: • Inject SUBCUT, taking care not to in ject intradermally
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Assess: • Pulse, B/P, ECG periodically during treatment; if using for CPR, monitor continuously • Diabetes insipidus: I&O ratio, weight daily; fluid/electrolyte balance, urine specific gravity; check for extreme thirst, poor skin turgor, dilute urine, large urine volume • Water intoxication: lethargy, behav- ioral changes, disorientation, neuromus- cular excitability • Small doses may precipitate coronary adverse effects; keep emergency equip ment nearby • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; breast- feeding women should pump and dis- card milk for 1½ hr after receiving product
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Evaluate: • Therapeutic response: absence of se vere thirst, decreased urine output, os molality
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To measure and record I&O • To avoid herbals, supplements, all OTC medications unless approved by prescriber • To report immediately hypersensitiv ity; wheezing; trouble breathing; rash; swelling of face, lips • To report adverse reactions promptly
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PHARMACOKINETICS IM: Onset 1 hr; duration 3-8 hr; IV duration 60 min; half-life 15 min; meta bolized in liver, kidneys; excreted in urine
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• Adult: IM/SUBCUT 5-10 units bid-qid as needed; CONT IV INFUSION 0.0005 units/kg/hr (0.5 milliunit/kg/hr), double dose q30min as needed
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• Adult: IV 0.01 units/min, titrate by 0.005 units/min q10-15min until B/P target is achieved, to max 0.07 units/min after target B/P of 8 hr without use of catecholamines; taper 0.005 units/min q1hr to maintain B/P GI hemorrhage (unlabeled)
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• Adult: IV 0.2-0.4 units/min, titrate, max 0.8 units/min
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