No

Antidiuretic Hormone Analog; Hormone, Posterior Pituitary

Treatment of diabetes insipidus; prevention and treatment of postoperative abdominal distention; differential diagnosis of diabetes insipidus

B

Hypersensitivity to vasopressin or any component

Use with caution in patients with seizure disorders, migraine, asthma, vascular disease, renal disease, cardiac disease; chronic nephritis with nitrogen retention. Goiter with cardiac complications, arteriosclerosis; I.V. infiltration may lead to severe vasoconstriction and localized tissue necrosis; also, gangrene of extremities, tongue, and ischemic colitis. Elderly patients should be cautioned not to increase their fluid intake beyond that sufficient to satisfy their thirst in order to avoid water intoxication and hyponatremia; under experimental conditions, the elderly have shown to have a decreased responsiveness to vasopressin with respect to its effects on water homeostasis

1% to 10%:

Cardiovascular: Increased blood pressure, bradycardia, arrhythmias, venous thrombosis, vasoconstriction with higher doses, angina

Central nervous system: Pounding in the head, fever, vertigo

Dermatologic: Urticaria, circumoral pallor

Gastrointestinal: Flatulence, abdominal cramps, nausea, vomiting

Neuromuscular & skeletal: Tremor

Miscellaneous: Diaphoresis

<1%: Myocardial infarction, water intoxication, allergic reaction

Symptoms of overdose include drowsiness, weight gain, confusion, listlessness, water intoxication

Water intoxication requires withdrawal of the drug; severe intoxication may require osmotic diuresis and loop diuretics

Decreased effect: Lithium, epinephrine, demeclocycline, heparin, and alcohol block antidiuretic activity to varying degrees

Increased effect: Chlorpropamide, phenformin, urea and fludrocortisone potentiate antidiuretic response

Store injection at room temperature; protect from heat and from freezing; use only clear solutions

Increases cyclic adenosine monophosphate (cAMP) which increases water permeability at the renal tubule resulting in decreased urine volume and increased osmolality; causes peristalsis by directly stimulating the smooth muscle in the GI tract

Nasal: Onset of action: 1 hour; Duration: 3-8 hours

Parenteral: Duration of action: I.M., S.C.: 2-8 hours

Absorption: Destroyed by trypsin in GI tract, must be administered parenterally or intranasally

Nasal:

Metabolism: In the liver, kidneys

Half-life: 15 minutes

Elimination: In urine

Parenteral:

Metabolism: Most of dose metabolized by liver and kidneys

Half-life: 10-20 minutes

Elimination: 5% of S.C. dose (aqueous) excreted unchanged in urine after 4 hours

Diabetes insipidus (highly variable dosage; titrated based on serum and urine sodium and osmolality in addition to fluid balance and urine output):

I.M., S.C.:

Children: 2.5-10 units 2-4 times/day as needed

Adults: 5-10 units 2-4 times/day as needed (dosage range 5-60 units/day)

Continuous I.V. infusion: Children and Adults: 0.5 milliunit/kg/hour (0.0005 unit/kg/hour); double dosage as needed every 30 minutes to a maximum of 0.01 unit/kg/hour

Intranasal: Administer on cotton pledget or nasal spray

Abdominal distention (aqueous): Adults: I.M.: 5 mg stat, 10 mg every 3-4 hours

GI hemorrhage: I.V. infusion: Dilute aqueous in NS or D₅W to 0.1-1 unit/mL

Children: Initial: 0.002-0.005 units/kg/minute; titrate dose as needed; maximum: 0.01 unit/kg/minute; continue at same dosage (if bleeding stops) for 12 hours, then taper off over 24-48 hours

Adults: Initial: 0.2-0.4 unit/minute, then titrate dose as needed, if bleeding stops; continue at same dose for 12 hours, taper off over 24-48 hours

Dosing adjustment in hepatic impairment: Some patients respond to much lower doses with cirrhosis

Serum and urine sodium, urine output, fluid input and output, urine specific gravity, urine and serum osmolality

Plasma: 0-2 pg/mL (SI: 0-2 ng/L) if osmolality <285 mOsm/L; 2-12 pg/mL (SI: 2-12 ng/L) if osmolality >290 mOsm/L

May cause dizziness

May be somewhat useful as a treatment for lithium-induced diabetes insipidus; HCTZ and amiloride are more effective, less expensive options

No information available to require special precautions

No effects or complications reported

Side effects such as abdominal cramps and nausea may be reduced by drinking a glass of water with each dose. Avoid alcohol use.

Watch for signs of I.V. infiltration and gangrene; elderly patients should be cautioned not to increase their fluid intake beyond that sufficient to satisfy their thirst in order to avoid water intoxication and hyponatremia; under experimental conditions, the elderly have shown to have a decreased responsiveness to vasopressin with respect to its effects on water homeostasis

Injection, aqueous: 20 pressor units/mL (0.5 mL, 1 mL)

Lindeman RD, Lee TD Jr, Yiengst MJ, et al, "Influence of Age, Renal Disease, Hypertension, Diuretics, and Calcium on the Antidiuretic Responses to Suboptimal Infusions of Vasopressin," J Lab Clin Med, 1966, 68(2):206-23.

Tuggle DW, Bennett KG, Scott J, et al, "Intravenous Vasopressin and Gastrointestinal Hemorrhage in Children," J Pediatr Surg, 1988, 23(7):627-9.