Page 177 - 2026 SMOG

VASOPRESSIN (VASOSTRICT)
Class/Mechanism of Action
• Antidiuretic Hormone Analog-Vasopressor
At therapeutic doses used for vasodilatory shock, it stimulates the V1 receptor and increases systemic
vascular resistance and mean arterial blood pressure. When the V2 receptor is stimulated, cyclic
adenosine monophosphate (cAMP) increases, increasing water permeability at the renal tubule,
resulting in decreased urine volume and increased osmolality. At pressor doses, it causes smooth
muscle contraction in the GI tract by stimulating muscular V1 receptors and the release of prolactin
and ACTH via V3 receptors.
˚ Onset of action—IV: Rapid, with peak effect occurring within 15min of initiation of continuous
IV infusion; Duration: Within 20min after IV infusion terminated
Indications
• Labeled Indications
˚ Treatment of hypotension, vascular failure in shock
Contraindications
• Hypersensitivity to Vasopressin or any component of the formulation
• Use with caution in patients with asthma, cardiovascular disease, renal disease, or a history of
seizure disorder
Adverse Reactions/Precautions
• Maximize use of Blood products/Crystalloids before considering use in hemorrhagic shock
secondary to norepinephrine.
• Assure adequate circulatory volume to minimize the need for vasoconstrictors. Monitor BP closely,
avoid hypertension, and adjust infusion rate as needed.
• May cause a decrease in heart rate and cardiac output due to V1 receptor stimulation
• Vesicant: Avoid extravasation—it will cause tissue damage/necrosis; ensure proper needle placement
• Cardiac arrhythmias are possible; monitor with 12-lead EKG
• Pregnancy: Use with caution; clearance in the 2nd and 3rd trimester—longer due to physiological
changes
• Lactation: Unknown
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Hypotension/Shock Hypotension/Shock (Limited data available;
• IV Infusion efficacy results have varied)
˚ 0.04 units/min infusion to maintain MAP • IV/IO Infusion
0.0002–0.002 units/kg/min
˚
>65mmHg
Note: Vasopressors should be used if the patient (0.2–2 milliunits/kg/min)
is hypotensive after fluid resuscitation to maintain Note: Titrate to the lowest effective dose
mean arterial pressure (MAP) ≥65mmHg
Note: Use in addition to norepinephrine for raising
MAP to target or to decrease norepinephrine
dosage
Note: Titrate to the lowest effective dose

2026 Standard Medical Operating Guidelines (SMOG) • 169