Peptide

Vasopressin

Natural hormone that retains water and constricts blood vessels. In intensive care it is infused to raise blood pressure in septic shock that does not respond to other vasopressors.

Regulatory status

Approved (FDA / EMA)

Family

Neurohypophyseal peptide hormone (V1/V2 agonist)

Scientific evidence

High

Number of findings

Where it acts

Heart and blood · Hormones and metabolism

Also known as

vasopressin, argipressin, arginine vasopressin, AVP, antidiuretic hormone, Vasostrict, Empressin

Regulatory status

FDA (US): Approved (2014, Vasostrict) to raise blood pressure in adults with vasodilatory hypotension (e.g., septic shock) that persists despite fluids and catecholamines

EMA (EU): No centralized authorization; authorized through a decentralized/national procedure (Empressin, in Spain since 2018) for catecholamine-refractory hypotension in septic shock

Dose

Continuous IV infusion of 0.01 IU/min, which may be increased every 15–20 min up to 0.03 IU/min; do not stop abruptly (AEMPS label, Empressin).

Safety

Ischemia (fingers, intestine, heart), arrhythmias, hyponatremia. Hospital use only and under medical supervision.

Interactions

Its effect increases with other vasopressors; drugs that release antidiuretic hormone (carbamazepine, chlorpropamide) may potentiate water retention.

Differences between women and men

Pregnancy: not recommended unless clearly necessary, because it can cause uterine contractions and reduce blood flow to the uterus (AEMPS label).

Effect by goal · level of evidence

Septic shock: does not reduce mortality versus norepinephrine

no clear effect High RCT (AA) in people

No significant difference

In VASST (778 patients), 28-day mortality was 35.4% with vasopressin and 39.3% with norepinephrine, a non-significant difference. In less severe shock there was a possible advantage (26.5% vs 35.7%).

View the study (RCT) →

In depth

Where it acts

Heart and blood, Hormones and metabolism

How it works

At low doses it activates V1 receptors in the blood vessels and constricts them, which raises blood pressure. In septic shock the body runs out of its own vasopressin, so replacing it helps reduce the norepinephrine dose. It also acts in the kidney (V2), retaining water.

What the evidence says

In people

Septic shock: does not reduce mortality versus norepinephrine. In VASST (778 patients), 28-day mortality was 35.4% with vasopressin and 39.3% with norepinephrine, a nonsignificant difference. In less severe shock there was a possible advantage (26.5% vs 35.7%). PubMed 18305265

References

PubMed 18305265

Information, not medical advice. Prescription or unapproved peptides should only be used under medical supervision.