Vasopressin (Injection)

Vasopressin is a manmade hormone designed to mimic that which is secreted by the pituitary gland, and is intended to boost healthy kidney function.

Overview

As a manmade anti-diuretic hormone, Vasopressin is designed to mimic the hormones naturally secreted by the pituitary gland. The artificial hormone is administered to help prevent water loss from the body by inhibiting urine production and aiding the kidneys in absorbing excess water. Additionally, Vasopressin raises the blood pressure by restricting blood vessels.

Conditions treated

  • Diabetes insipidus

Type of medicine

  • Anti-diuretic

Side effects

In addition to the intended results of taking Vasopressin, the medication may also have unintended side effects on the patient. Each patient will react differently and may experience only a few side effects, but any adverse reactions should be reported to the patient's doctor. Among the more common side effects, the patient may experience stomach pain or abdominal discomfort. This may most often occur after eating a meal. Chest pain or discomfort may also be a side effect of the medication and, if this occurs, the patient should see their doctor as soon as possible.

Other common side effects include agitation, back pain and dizziness, which may lead to fainting. The patient may also experience muscle twitching or muscle pain and cramps. Pain in the shoulders, arms, neck or jaw may also occur. Some patients reported experiencing a tightness or heaviness in the chest, as well.

A lack of blood pressure readings and an inability to locate a pulse have also been reported, and may occur as another side effect of taking Vasopressin. Swelling or puffiness may manifest, particularly around the patient's face, around the eyelids or eyes, lips, or tongue. Similarly, the skin of the arms and legs may also be affected, appearing pale or blotchy. The patient's skin may also feel unusually cool to the touch. Constipation, a frequent or persistent cough, and a decreased ability to urinate may also result from taking the medication.

More serious side effects include convulsions, confusion and the possibility of a coma. Additionally, the patient may experience depression, seizures, or heart failure.

Diarrhea, difficulty with swallowing, dilated neck veins and extreme fatigue are more possible side effects that can result from treatment. Patients may also be found in a stupor, sweating excessively, or swelling around the lower legs, including the ankles and feet.

In separate instances, some patients experienced increased heart rates, while others were affected by slowed heart rates. In either circumstance, the symptom should be reported to a physician as soon as possible. There may also be episodes of unconsciousness, extreme tiredness and weakness, headaches and unexplained hostility. Some individuals developed rashes or hives, accompanied by itching.

Other side effects that should be promptly shared with the patient's physician include excessive thirst, irregular breathing, irritability, and lethargy.

In some cases, Vasopressin can induce an immediate reaction, once treatment has begun with the first dose. For this reason, patients should immediately report sudden side effects to their caregiver. Symptoms of a reaction include nausea, weakness, lightheadedness or dizziness, or sweating. Other signs that an adverse reaction has occurred include weak breathing, chest discomfort or tightness, or an increased heartbeat.

Just after receiving a Vasopressin dose, the patient can manifest blanching of the skin (white spots that result from pressing on the skin), nausea, and stomach pain or discomfort. The patient can alleviate these effects by drinking one or two glasses of water, prior to receiving each dose.

Because Vasopressin induces peripheral vasoconstriction, dermatological effects can be experienced by the patient. This means the patient may experience any of the following symptoms: sweating, alopecia, cutaneous necrosis or infarcts, and gangrene. However, if these conditions manifest in the patient, it's likely they will do so while they are still at the treatment facility. Healthcare providers should be notified immediately, so treatment can be implemented to reduce or eliminate these effects.

The immune system may develop antibodies to combat the presence of Vasopressin. This can cause an obstacle to the intended diuretic effect of the drug. As a result, caregivers should be watchful for signs of severe anaphylaxis or urticaria.

Vasopressin can also have gastrointestinal effects on the body. Mesenteric artery thrombosis (MAT), accompanied by retrograde propagation of the thrombus into the portal vein, has been reported in some instances. This may induce bowel necrosis in the patient, where bacterial peritonitis secondary to thrombosis of the superior mesenteric artery may or may not be produced. However, the correlation between the administering of Vasopressin treatments and the development of mesenteric artery thrombosis may be coincidental. Research has found that up to 10% of patients with liver cirrhosis show signs of portal vein thrombosis without Vasopressin treatment.

Symptoms of gastrointestinal problems resulting from Vasopressin treatments include abdominal cramps, nausea and vomiting, diarrhea, and flatulence. These symptoms have been found in 18% of patients. It should be noted that unexplained stomach pain has been documented by patients on Vasopressin, where they never developed mesenteric or portal vein thrombosis or bowel necrosis.

Renal side effects are rare, having occurred in only two patients. In both cases, the patients experienced myoglobinuria with acute renal failure. The condition was caused by skeletal muscle ischemia which was induced by the Vasopressin drug treatments.

The nervous system can be affected by the Vasopressin drug therapy as well. Signs that a patient is having a nervous system response to the drug can manifest as tremors, pounding headaches, or incidences of vertigo. Similarly, there have been occasions where the patient's respiratory system was affected by the treatments. Doses of Vasopressin an cause bronchial constriction, pulmonary edema, and adult respiratory distress syndrome (ARDS).

Dosage

Vasopressin is administered by a trained healthcare professional in a hospital setting. Given intravenously, the medication's measurements are as follows: 20 units/mL, 1 unit/mL-D5% and 20 units/100 mL-D5%. Diabetes insipidus is treated with between five and 10 units, though the exact dosage is left to the doctor's discretion. The treatment is given intramuscularly or subcutaneously and administered anywhere between twice per day up to four times a day.

A continuous IV infusion of 0.0005 units/kg/hour may be administered or double doses up to 0.01 units/kg/hour can otherwise be administered every 30 minutes.

Less common forms of treatment allow for administering Vasopressin intranasally on cotton swabs. It may also be given to the patient in the form of a nasal spray or a dropper. In cases where the treatment is administered via nasal spray or on cotton swabs, the dosage must be individually titrated for the patient.

Interactions

Before beginning treatment with Vasopressin, the doctor and patient should discuss the patient's medications, past and present. In addition to prescription medications, the patient should also inform the doctor of all non-prescription drugs they have been taking. This includes vitamins, herbal supplements and recreational narcotics that the patient may have been taking.

Specific drugs known to have interacted negatively with Vasopressin include epinephrine injections (Adrenaclick, Auvi-Q, EpiPen, or EpiPen Jr), Demeclocycline, and lithium. Additionally, the patient should report having been prescribed antidepressants, such as Celexa (citalopram), Khedezla or Pristiq (desvenlafaxine), Cymbalta (duloxetine), and Lexapro (escitalopram). Other drugs to show signs of adverse interactions with Vasopressin include Aptiom (eslicarbazepine acetate) and Equetro, Tegretol, or Carbatrol (carbamazepine). Fetzima (levomilnacpran) and Savella (milnacipran) have also affected the way Vesopressin interacts with the body.

Patients who have been taking laxatives should also advise their physicians. Both laxatives and bowel preparation medications can cause unwanted reactions when combined with a Vasopressin treatment. Additionally, drinking alcohol while being administered a Vasopressin therapy can result in an adverse reaction. The combination can cause headaches, nausea, and sweating.

While there haven't been any reports of bad interactions with Vasopressin and grapefruit juice, the drug manufacturer suggests there may be the possibility. While the liver can break down Vasopressin, it's not known if chemical compounds found in the grapefruit are broken down similarly. For that reason, it's suspected that an adverse reaction could occur. Patients are recommended to abstain from consuming grapefruit juice while undergoing Vasopressin treatments.

Since Vasopressin acts to boost coronary and systemic vascular resistance, it has been known to cause myocardial ischemia, reduced cardiac output and systemic hypertension. The risk of developing these conditions can be reduced through treatments of nitroglycerin or isoproterenol.

Patients with a history of coronary artery or peripheral vascular disease should be monitored closely for cardiovascular side effects. Patients with any chronic kidney condition should not be placed on the Vasopressin drug therapy. Asthma sufferers are also subject to complications, when taking the drug, urging healthcare providers to take special caution in treating such patients.

Warnings

Water consumption should be closely monitored while the patient is receiving Vasopressin doses. If the patient is not drinking enough water, it may defeat the effectiveness of the drug therapy. However, drinking too much water could also cause serious health risks, so it's important for the patient to adhere to the doctors dietary restrictions and instructions. By following that advice precisely, the patient can achieve the best possible results from treatment.

In rare instances, Vesopressin has induced a state of water intoxication in the patient. Signs of this condition include listlessness, drowsiness, and headaches. It's important to recognize and treat this condition early, because, if left unchecked, it could cause convulsions and a terminal coma. Similarly, patients suffering from conditions that may be worsened from a rapid addition of extracellular water should be monitored by their healthcare provider.

Vasopressin should not be administered to patients with chronic nephritis, particularly when accompanied by nitrogen retention. Treatment can be delayed, until nitrogen levels in the patient's blood return to normal. Once the doctor detects a more normal reading, the drug therapy can be safely initiated.

In pregnant women, Vasopressin has been used effectively to treat diabetes insipidus. This may be due to the decrease found of the natural hormone in pregnant women. In the first and second trimesters, studies found decreased plasma concentration of vasopressin, while the hormone levels dropped three times as much in the third trimester. Vasopressin levels remained significantly low, while the patient was in labor. Taking the Vasopressin therapy may actually benefit the pregnancy, because higher levels have shown a boost in the frequency and amplitude of uterine contractions.

Breastfeeding mothers have reported no adverse reactions while on Vasopressin. Patients have breastfed normally and haven't reported any problems or any ill effects on their babies. Even so, the drug manufacturer suggests caution and careful monitoring, when breastfeeding an infant while on the drug.

Storage

When Vasopressin is manufactured, it comes in a sterile, filtered white powder, which is freeze dried for shipment. When it's ready for use, the Vasopressin powder should be reconstituted with 18MΩ-cm H2O not less than 100 µg/ml.

In the freeze dried powder form, Vasopressin can be stored at room temperature for up to three weeks. Once the solution has been reconstituted, it should be stored at 4°C for the first two days, up to one week. After that, reconstituted Vesopressin needs to be stored at or below -18°C for future use. If long term storage is necessary, a carrier protein at 0.1% HSA or BSA is recommended.

Summary

In treating diabetes insipidus, Vasopressin can be an effective drug therapy. As with any medication, it's important for the doctor and patient to communicate fully to minimize the risk of experiencing harmful side effects or adverse reactions. This means being forthright in sharing prescription, over the counter and illegal drug use, as well as mentioning any herbal remedies or vitamins the patient happens to be taking. Likewise, certain medical conditions can complicate the treatment and possibly risk the patients safety, if not disclosed ahead of treatment. Working together, the doctor and patient can achieve the maximum benefits provided by Vasopressin drug therapy and restore the individual to a better state of health.

The drug treatment should be accompanied by regular laboratory testing. Regular updates on the patient's status should be determined through electrocardiograms (ECG) and through testing their fluid and electrolyte levels. This requires regular follow up visits, which the patient should be diligent in pursuing. A missed appointment or cancelled office visit could cause the doctor to overlook an unexpected adverse reaction. In such a case, the treatment may not take effect, or the patient's health can be placed at greater risk. Following through with the entire plan for treatment can ensure a more certain and more rapid recovery. Vasopressin can promote better kidney health, but only when the proper treatment is followed.

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Last Reviewed:
December 25, 2017
Last Updated:
April 05, 2018
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