Vasopressin Medications in Vasodilatory Shock
Indications and Usage
- The American College of Cardiology recommends vasopressin as a second-line vasopressor in vasodilatory shock, particularly septic shock, when patients remain hypotensive despite fluids and first-line catecholamines 1
- Vasopressin is indicated for the management of acute variceal hemorrhage in cirrhosis, with a typical dose of 0.2-0.4 units/minute, which can be increased to a maximum of 0.8 units/minute, accompanied by IV nitroglycerin 2
Dosage and Administration
- The recommended dose of vasopressin for septic shock is 0.01 to 0.07 units/minute, and it should not be used as the single initial vasopressor for septic shock 1
- Doses higher than 0.03-0.04 units/minute should be reserved for salvage therapy when other vasopressors have failed, according to the Society of Critical Care Medicine 4, 1
Contraindications and Precautions
- Terlipressin is contraindicated in patients experiencing hypoxia, worsening respiratory symptoms, or ongoing coronary, peripheral, or mesenteric ischemia, as stated by the Gastroenterology society 3
Adverse Reactions and Side Effects
- Terlipressin-specific side effects include abdominal pain, chest pain, diarrhea, and hyponatremia, as reported by the Gastroenterology society 3, 5
Evaluation and Desired Outcomes
- The primary outcome of vasopressin therapy is the achievement of target mean arterial pressure, typically 65 mmHg in septic shock, as recommended by the Critical Care Medicine society 4, 1
- Control of variceal bleeding is a secondary outcome when vasopressin is used for this indication, with a success rate supported by the Hepatology and Gut societies 2, 7
Comparative Efficacy
- The Gastroenterology society recommends octreotide as the vasoactive drug of choice for variceal hemorrhage due to its superior safety profile compared to vasopressin 3, 5
- For septic shock, the Critical Care Medicine society recommends norepinephrine as the first-line vasopressor, with vasopressin as an adjunctive agent 4, 1