Vasopressin adverse effects

Common adverse effects (skin blanching, abdominal cramps, and nausea) maybe reduced by taking 1-2 glasses of waterwith the dose of vasopressin self-limited in... 

Terlipressin is a vasopressin analog that appears to have similar efficacy to vasopressin with fewer adverse effects. Although this agent is available in other countries, it has never been approved for use in the USA. 

A review has suggested that terlipressin has fewer adverse effects than vasopressin however, the studies on which this was based were rated as low in quality (4). 

The use of vasopressin and terlipressin for the management of septic shock has been reviewed a maximum dose of 0.04 U/minute is recommended (5). Vasopressin 0.23 U/minute in patients with hepatorenal syndrome did not appear to be associated with the adverse effects that occur at the lower doses that are used to treat other critically ill patients (6). 

Although vasopressin and its analogues have been used in the acute management of bleeding esophageal varices, they do not reduce mortality (2,3) and the rate of adverse effects is higher than with octreotide (3). 

Dose-related adverse effects of vasopressin include skin pallor, hypertension, cardiac dysrhythmias, and myocardial ischemia or infarction treatment has to be stopped in 20-30% of patients because of these effects (3). 

A review of trials has suggested that vasopressin is more likely to cause adverse effects at doses of 0.04 U/minute or more when it is used to treat septic shock mesenteric ischemia and cardiac dysfunction and ischemia were particularly associated with high doses (30). The authors suggested that limiting the dosage to 0.03 U/minute may minimize these effects. This suggestion has been supported by a retrospective audit of the effects of continuous vasopressin infusion in septic shock in 102 men and women, mean age 53 years (31). There were adverse events that may have been linked to vasopressin in 18 patients cardiac arrest (n = 9) ischemic/mottled digits (n = 8) myocardial infarction (n = 1) and hyponatremia (n = 1). Adverse events occurred with doses of vasopressin of 0.04 units/minute and over, except in one patient (dose not stated). 

The authors reviewed nine other reported patients with MDMA-related SIADH, all of whom were women. They concluded that MDMA-associated SIADH is multifactorial and that MDMA may stimulate vasopressin secretion in susceptible individuals. They further suggested that hyponatremia can also occur secondary to voluntary increases in fluid or water intake aimed at preventing the adverse effects of MDMA. With appropriate treatment, full recovery is possible in almost all cases of this life-threatening condition. 

Most adverse effects are mediated through the Vj receptor acting on vascular and GI smooth muscle consequently, such adverse effects are much less common, and less severe, with desmopressin than with vasopressin. After the injection of large doses of vasopressin, marked facial pallor owing to cutaneous vasoconstriction is observed commonly. Increased intestinal activity is likely to cause nausea, belching, cramps, and an urge to defecate. Most serious, however, is the effect on the coronary circulation. Vasopressin should be administered only at low doses and with... 

Mild facial flushing and headache are the most common adverse effects associated with desmopressin. Allergic reactions ranging from urticaria to anaphylaxis may occur with desmopressin or vasopressin. Intranasal administration may cause local adverse effects in the nasal passages, such as edema, rhinorrhea, congestion, irritation, pruritus, and ulceration. 

The major receptor-mediated adverse effect is water intoxication, which can occur with desmopressin or vasopressin. Many drugs, including carbamazepine, chlorpropamide, morphine, tricyclic antidepressants and NSAIDs, can potentiate the antidiuretic effects of these peptides, while lithium, demeclocycline and ethanol can attenuate the antidiuretic response to desmopressin. Desmopressin and vasopressin should be used cautiously when a rapid increase in extracellular water may impose risks (e.g., in angina, hypertension, and heart failure) and should not be used in patients with acute renal failure. Patients receiving desmopressin to maintain hemostasis should be... 

Adverse reactions to carbamazepine include nystagmus, ataxia, diplopia, particularly if the dosage is raised too fast. Gastrointestinal problems and skin rashes are frequent It exerts an antidiuretic effect (sensitization of collecting ducts to vasopressin water intoxication). 

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