| Vasopressin | |
| Receptor binding | V1, V2 |
| Pharmacology | Agonism of V1 receptors on smooth muscle causes vasoconstriction Agonism of V2 receptors in nephron induces translocation of aquaporin water channels to plasma membrane of collecting duct cells |
| Dosing range | Fixed dose: 0.04 units/min |
| Clinical scenarios to consider it | When avoiding β agonism is desired (e.g. left ventricular outflow obstruction, tachyarrhythmia) or when trying to reduce dose of first line agent Hypotension accompanied by severe acidosis Second line agent in refractory vasodilatory/septic shock |
| Clinical pearls | Vasoconstrictive effect is relatively preserved despite conditions of hypoxia and acidosis (which can attenuate effects of catecholamines) Doses above 0.04 units/min have been associated with coronary and mesenteric ischemia and skin necrosis Rebound hypotension often occurs after withdrawal of vasopressin. To avoid this, the dose is slowly tapered by 0.01 units/min every 30 minutes |
Reading list
1 Bangash MN, Kong M‐L, Pearse RM. Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol 2012; 165:2015–33.
2 Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J. Low‐dose dopamine in patients with early renal dysfunction: a placebo‐controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 2000; 356:2139–43.
3 De Backer D, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010; 362:779–89.
4 Dellinger RP, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39:165–228.
5 Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med 2011; 183:847–55.
6 Holmes CL. Vasoactive drugs in the intensive care unit. Curr Opin Crit Care 2005; 11:413–17.
7 Jentzer JC, Coons JC, Link CB, Schmidhofer M. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. J Cardiovasc Pharmacol Ther 2015; 20:249–60.
8 Overgaard CB, Dzavik V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation 2008; 118:1047–56.
9 Unverferth DA, Blanford M, Kates RE, Leier CV. Tolerance to dobutamine after a 72 hour continuous infusion. Am J Med 1980; 69:262–6.
10 Vincent JL, De Backer D. Circulatory shock. N Engl J Med 2013; 369:1726–34.
Additional material for this chapter can be found online at:
www.wiley.com/go/mayer/mountsinai/criticalcare
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