vasopressin

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

Indication

  • An antidiuretic hormone analogue used to treat vasodilatory shock with hypotension unresponsive to fluid resuscitation or exogenous catecholamines
  • Treatment of refractory persistent pulmonary hypertension of the newborn (PPHN)
  • Treatment of central diabetes insipidus

Dosage Guidelines

Note: Units of measure vary by indication, use caution when checking dosing units

  • Sepsis, catecholamine and corticosteroid resistant shock, PPHN: 0.1-2 milliunits/kg/min IV
  • Diabetes insipidus: 0.5-10 milliunits/kg/hr IV
  • Titrate to effect every 30 minutes

Administration

  • IV continuous infusion

  • For sepsis, catecholamine and corticosteroid resistant shock, PPHN in patients 3 kg or less: Use vasopressin 0.04 units/mL

    To make 50 mL of vasopressin [0.04 units/mL] solution:

    Add 0.1 mL (2 units) of vasopressin [20 units/mL] to 49.9 mL of solution

  • For sepsis, catecholamine and corticosteroid resistant shock PPHN in patients over 3 kg:  Use vasopressin 0.2 units/mL

    To make 50 mL of vasopressin [0.2 units/mL] solution:

    Add 0.5 mL (10 units) of vasopressin [20 units/mL] to 49.5 mL of solution

  • For diabetes insipidus in patients 5 kg or less: Use vasopressin 0.0008 units/mL

    To make 50 mL of vasopressin [0.0008 units/mL] solution:

    Call Pharmacy as requires a double dilution

  • For diabetes insipidus in patients over 5 kg:  Use vasopressin 0.04 units/mL

    To make 50 mL of vasopressin [0.04 units/mL] solution:

    Add 0.1 mL (2 units) of vasopressin [20 units/mL] to 49.9 mL of solution

Adverse Effects

  • Hypertension, bradycardia, arrhythmias, heart block, hyponatremia, water intoxication, bronchoconstriction transient thrombocytopenia, and rarely focal hepatic necrosis.

Comments

  • Monitor blood pressure and heart rate, urine output, serum sodium levels and total fluid intake
  • Abrupt discontinuation of the infusion may result in hypotension.  Gradually taper infusion to discontinue.
  • Frequent assessment of fluid balance is warranted during vasopressin infusion .
  • Monitor IV site closely as extravasation may lead to severe vasoconstriction and localized tissue necrosis

Supplied As

  • 20 units/mL injection (2 mL vial)
  • Patient specific syringes: 0.0008 units/mL, 0.04 units/mL or 0.2 units/mL depending on patient weight and indication
  • At LHSC, standard concentration reference charts are available on the NICU Intranet site

References

LexiComp Sick Kids, LexiComp Pediatric and Neonatal