What is the maximum dose of vasopressin (antidiuretic hormone) for intrauterine fibroid injection?

From the Guidelines

The maximum recommended dose of vasopressin for intra-fibroid injection is not explicitly stated in the provided evidence, however, based on general medical knowledge and standard practices, a commonly used dose is 20 units total. When performing the injection, it's crucial to aspirate before injecting to avoid intravascular administration, which could cause severe hypertension or other cardiovascular complications 1. The injection should be done slowly and carefully, monitoring the patient's vital signs throughout the procedure. Vasopressin works by causing vasoconstriction of small blood vessels, which reduces blood flow to the fibroid and creates a relatively bloodless surgical field during myomectomy procedures. This hemostatic effect is temporary, typically lasting 30-45 minutes, which is usually sufficient time to complete the surgical removal of the fibroid. Some key points to consider when administering vasopressin include:

• Patients with cardiovascular disease, especially coronary artery disease, should receive vasopressin with caution due to its vasoconstrictive properties.
• The procedure should be performed by an experienced healthcare provider in a setting equipped to handle potential complications.
• The patient's medical history and current health status should be carefully evaluated before administering vasopressin. It's also important to note that uterine fibroids can have a significant impact on quality of life and fertility, and treatment options should be carefully considered based on individual patient needs and preferences 1. In addition to vasopressin, other treatment options for uterine fibroids include medical therapy, myomectomy, endometrial ablation, uterine fibroid embolization, and laparoscopic radiofrequency ablation. The choice of treatment should be based on the patient's symptoms, medical history, and personal preferences, as well as the potential risks and benefits of each treatment option.

From the Research

Maximum Dose of Vasopressin for Intrauterine Fibroid Injection

• The maximum dose of vasopressin for intrauterine fibroid injection is not explicitly stated in the provided studies.
• However, the studies report the use of vasopressin at various concentrations and doses, including:
  • 0.05-0.3 units/mL 2
  • 0.2 IU/ml, 0.1 IU/ml, and 0.05 IU/ml with a total of 100 ml of normal saline 3
  • 11 units (0.2 units/mL) 2
  • 20 units (1 unit/ml) 4
• It is worth noting that the use of vasopressin can cause significant side effects, including bradycardia, cardiac arrest, and severe vasospasm, even at low doses 2, 4.
• The study by 3 found that vasopressin diluted in a volume of 100 ml showed an effective hemostatic effect and safety during robot-assisted laparoscopic myomectomy, but two patients in the group with the highest concentration (0.2 IU/ml) showed vasopressin-related hypertension.
• Another study 5 used 20 units of vasopressin for subendometrial injection to control bleeding in postpartum hysterectomy due to abnormally invasive placenta, and found that it significantly reduced bleeding compared to the control group.