Vasopressors and inotropes
Vasopressin (Vasostrict) drip
Vasostrict, Pitressin
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Dosing
| Start | 0.03 units/min, usually fixed (some start at 0.01) |
|---|---|
| Titrate | Usually not titrated; label allows 0.005 units/min steps every 10–15 minutes |
| Maximum | 0.04 units/min in common practice; label up to 0.07 in septic shock |
| Common bags | 20 units in 100 mL (0.2 units/mL); 40 units in 100 mL (0.4 units/mL) |
| Dose units | units/min |
Line and administration
- Central line preferred
Watch for
- Digital, skin and gut ischemia
- Low sodium
- Lower cardiac output and heart rate
Vasopressin: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Vasopressin: V1 (V2 in kidney): ↔ or ↓ / ↔ / ↑↑
- Toxidromes and AntidotesCardiotoxic drugs: Local anesthetics: 20% lipid 1.5 mL/kg (up to 100 mL), then infusion: Small epinephrine doses; no vasopressin
- ACLS Algorithms in BriefCPR quality, shocks and drugs: Not routine in arrest: calcium, bicarbonate, magnesium, vasopressin, high-dose epinephrine, pacing. Hyperkalemic arrest: calcium and bicarbonate may be considered (2025: benefit unproven).
- Obstetric EmergenciesSepsis and venous thromboembolism: SMFM #47: antibiotics within 1 h, cultures, lactate, source control, 1–2 L of crystalloid, norepinephrine first, and no delivery for sepsis alone. Vasopressin at a fixed 0.03 units/min is a reasonable second pressor, and stress-dose hydrocortisone is held while antenatal steroids are given (Bauer and Pacheco 2025).
- Prehospital SepsisVasopressors in transport: Second agent: Vasopressin 0.03 units/min, fixed, as norepinephrine climbs
- Pulmonary EmbolismSupporting the failing RV: Norepinephrine first: keeps aortic above RV pressure; vasopressin second
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.