From the FDA Drug Label
DOSAGE AND ADMINISTRATION Dilute 20 units/mL multiple dose vial contents with normal saline (0.9% sodium chloride) or 5% dextrose in water (D5W) to either 0. 1 units/mL or 1 unit/mL for intravenous administration. Post-cardiotomy shock: 0.03 to 0.1 units/minute
The FDA drug label does not provide a specific dose for cardiogenic shock. The dose provided is for post-cardiotomy shock which may not be directly applicable to cardiogenic shock.
- The recommended dose for post-cardiotomy shock is 0.03 to 0.1 units/minute 1. However, this information cannot be used to determine the dose for cardiogenic shock. The FDA drug label does not answer the question.
From the Research
Vasopressin should be used in cardiogenic shock at a dose of 0.01-0.04 units/minute as a continuous intravenous infusion, with a preference for starting at the lower end of the range (0.01 units/minute) and titrating up as needed based on blood pressure response and clinical improvement, as evidenced by recent studies 2, 3.
Key Considerations
- The use of vasopressin in cardiogenic shock is supported by its ability to cause peripheral vasoconstriction through V1 receptors on vascular smooth muscle, helping to maintain blood pressure and organ perfusion without significantly increasing myocardial oxygen demand 2.
- Vasopressin is particularly useful when combined with other vasopressors like norepinephrine or as a catecholamine-sparing agent in patients who have developed tachyphylaxis to traditional vasopressors 4.
- Monitoring for potential side effects including digital and splanchnic ischemia, hyponatremia, and decreased cardiac output is crucial, along with regular assessment of perfusion parameters, urine output, and end-organ function during vasopressin administration 3.
Dosing and Administration
- The maximum recommended dose of vasopressin is typically 0.04 units/minute, and doses higher than this generally do not provide additional benefit while potentially increasing adverse effects 2.
- The choice of vasopressin over other agents like norepinephrine or epinephrine may depend on specific patient factors and the underlying cause of cardiogenic shock, with norepinephrine often being the first-line agent for vasodilatory shock 4, 5.
Clinical Context
- In clinical practice, the use of vasopressin should be guided by the principles of minimizing morbidity, mortality, and improving quality of life, with careful consideration of the patient's overall clinical status and response to treatment 2, 3.
- Recent studies suggest that vasopressin may be a viable alternative to traditional vasopressors in certain cases, although more research is needed to fully establish its efficacy and safety in cardiogenic shock 3, 4.