Vasopressin (Vasostrict)

Summary

Vasopressin is the nine amino acid antidiuretic (water retaining) hormone released by the back of the pituitary gland; as a drug it is an intravenous vasopressor (a blood pressure raising drug) FDA approved in 2014 (Vasostrict) to raise blood pressure in vasodilatory shock, dangerously low blood pressure from widened blood vessels. In the 778 patient VASST trial, adding low dose vasopressin to norepinephrine in septic shock (shock from infection) did not change 28 day mortality (35.4% versus 39.3%), and the 409 patient VANISH trial found no reduction in kidney failure, though fewer patients needed dialysis. It is a hospital only drug with no role outside critical care, and the vasopressin sold online as a nootropic (supposed memory enhancer) or nasal spray has no supporting evidence.

What is Vasopressin?

Vasopressin is an endogenous nonapeptide hormone of the posterior pituitary (V1a, V1b, and V2 receptor agonist). It is also known as Arginine vasopressin, AVP, Antidiuretic hormone, ADH, Vasostrict, 8-arginine vasopressin.

How does it work?

Vasopressin acts on V1a receptors on vascular smooth muscle to cause vasoconstriction, on V2 receptors in the renal collecting duct to insert aquaporin channels and concentrate urine, and on V1b receptors in the pituitary to release ACTH. In septic shock, endogenous vasopressin is relatively deficient, which is the rationale for low dose replacement. It also acts as a neurotransmitter involved in social behavior in animals, the basis for research interest in intranasal use.

FDA-approved uses of Vasopressin

Yes, as Vasostrict since 2014. The label covers one use: increasing blood pressure in adults with vasodilatory shock, dangerously low blood pressure from widened blood vessels (for example septic or post cardiac surgery shock), who remain hypotensive (low blood pressure) despite fluids and catecholamines, the standard blood pressure drugs such as norepinephrine. Generic vasopressin injections followed. It is given only by intravenous infusion in hospital. [3]

What does the evidence say about Vasopressin?

Two large randomized trials in septic shock. VASST (n = 778): vasopressin 0.01 to 0.03 units per minute plus norepinephrine versus norepinephrine alone; 28 day mortality 35.4% versus 39.3% (not significant), with a possible benefit in less severe shock. VANISH (n = 409): early vasopressin versus norepinephrine; kidney failure free days did not differ, but fewer vasopressin patients received renal replacement therapy (25.4% versus 35.3%). Both trials support vasopressin as a safe norepinephrine sparing agent rather than a survival improving one. Approval for post cardiotomy and septic shock rests on these and hemodynamic studies.

Human evidence

Russell 2008 (VASST): 778 patients with septic shock on at least 5 ug/min norepinephrine randomized to add vasopressin 0.01 to 0.03 units/min or more norepinephrine; 28 day mortality 35.4% versus 39.3% (p = 0.26), 90 day mortality 43.9% versus 49.6% (p = 0.11); in the prespecified less severe shock stratum 28 day mortality was 26.5% versus 35.7%. Gordon 2016 (VANISH): 409 adults with septic shock randomized in a factorial design to vasopressin (up to 0.06 units/min) or norepinephrine, with hydrocortisone or placebo; kidney failure free days did not differ, renal replacement therapy 25.4% versus 35.3%, mortality 30.9% versus 27.5% (not significant). No randomized trial supports intranasal vasopressin for cognition, social behavior, or muscle growth.

Animal evidence

Animal work characterized receptor pharmacology and the role of vasopressin in water balance, blood pressure, and stress responses. Rodent and vole studies show vasopressin shapes pair bonding, aggression, and social memory, which prompted small human intranasal studies with mixed results. Sepsis models show relative vasopressin deficiency and improved hemodynamics with replacement.

Key studies

Is Vasopressin legal in the United States?

FDA and compounding status

Vasopressin injection was marketed for decades as an unapproved drug and became FDA approved as Vasostrict in April 2014 for vasodilatory shock; generic vasopressin injections were approved beginning in 2021. Hospital pharmacies may prepare diluted infusions from approved vials. Vasopressin sold online for intranasal use as a cognitive or social enhancer is not an approved product and is not compounded by licensed pharmacies for that purpose.

WADA status

WADA status unclear. The current prohibited list does not name this compound explicitly and its class status is not settled. Athletes should ask their anti-doping organization before use.

Regulatory timeline

No regulatory events recorded.

Full tracker for Vasopressin or the category-wide tracker.

Vasopressin dose on the FDA label

Doses below are quoted from the FDA label for its approved uses, plus the doses used in the pivotal trials where noted. The prescriber sets the dose; PeptideAgent does not recommend doses or protocols.

FDA label (Vasostrict, DailyMed; continuous intravenous infusion in hospital, diluted to 0.1 or 1 unit/mL unless supplied premixed): post cardiotomy shock, 0.03 to 0.1 units per minute; septic shock, 0.01 to 0.07 units per minute. The label gives no subcutaneous, intranasal, or other outpatient dose.

Routes reported

What are the side effects and interactions of Vasopressin?

Side effects

Interactions

Contraindications

How do people access Vasopressin legally?

Typical cost: Hospital only; a 20 unit vial of generic vasopressin costs roughly 30 to 150 USD to the hospital and is billed as part of ICU care. No outpatient product exists.

• Rules by state
• Verified provider directory

Frequently asked questions

Decisions about starting, stopping, or combining any treatment belong with a licensed clinician who knows your history.

Sources

Numbered citations above point to these primary sources. PubMed entries link to the indexed abstract.