Vasopressin dose
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vasopressin septic shock dose
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Here is a complete, textbook-sourced summary of vasopressin dosing across clinical contexts:
Vasopressin Dosing
1. Septic Shock / Vasodilatory Shock
| Indication | Dose | Notes |
|---|---|---|
| Septic shock (add-on to norepinephrine) | 0.03 units/min (up to 0.03 U/min) | Not titrated; fixed dose to spare catecholamines |
| Vasoplegic/vasodilatory shock (general range) | 0.01 - 0.06 units/min | Add when norepinephrine requirements increase significantly (>5 mcg/min) |
| Septic shock (Sabiston recommendation) | 0.04 units/min | Fixed low-dose; high-dose vasopressin is NOT recommended |
- Vasopressin provides pure vasoconstriction with no inotropic effect.
- It is added to norepinephrine (not used as monotherapy) when catecholamine doses escalate.
- It does not clearly reduce mortality vs. norepinephrine alone, but may reduce norepinephrine requirements and lower the risk of atrial fibrillation.
- Goldman-Cecil Medicine, p. 3620; Sabiston Textbook of Surgery, p. 2873; Current Surgical Therapy, p. 1569
2. Cardiac Arrest (ACLS)
| Route | Dose | Notes |
|---|---|---|
| IV / IO | 40 units (single bolus) | Can substitute for 1st or 2nd dose of epinephrine |
- Most studies show no superiority over epinephrine.
- As of 2019 AHA guidelines, vasopressin was removed from the ACLS algorithm - epinephrine 1 mg IV every 3-5 min is the preferred agent.
- Tintinalli's Emergency Medicine, p. 4175; Miller's Anesthesia, p. 4887
3. Postoperative Vasoplegic Shock
- 0.01 - 0.06 units/min IV infusion
- Shown superior to high-dose norepinephrine in postoperative vasoplegic shock (benefit mainly in patients on preoperative ACE inhibitors/ARBs; reduced renal failure, fewer AF episodes).
- Current Surgical Therapy, p. 1569
4. Intramyometrial Use (Gynecologic Surgery / Obstetrics)
- Maximum safe dose is not well established, but < 5 units total is recommended.
- Risk of intravascular injection causing cardiovascular collapse.
- Berek & Novak's Gynecology, p. 32
Key Points
- Mechanism: V1 receptor agonist → vasoconstriction; V2 receptor agonist → water retention (antidiuretic effect).
- High-dose vasopressin is not recommended in septic shock (risk of mesenteric/digital ischemia).
- Vasopressin does not cause tachycardia (unlike catecholamines), making it useful in arrhythmia-prone patients.
- Cost consideration: ~$550/day vs. ~$20/day for norepinephrine.
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