Search
Pitressin (vasopressin, antidiuretic hormone, ADH)
Tradename: Pitressin.
Indications:
1) used to control polyuria, polydipsia & dehydration in patients with diabetes insipidus
2) used to control massive hemorrhage
3) adjunct in treatment of GI hemorrhage & bleeding esophageal varices
4) prevention & treatment of post-operative abdominal distension
Contraindications: Caution:
1) seizure disorder
2) migraine
3) asthma
4) vascular disease
5) renal disease
6) cardiac disease
Pregnancy category: C
Safety in lactation ?
Dosage:
1) diabetes insipidus:
a) adults: 5-10 units IM/SC BID-QID PRN (5-60 units/day)
b) children: 2.5-5 units IM/SC BID-QID PRN
c) intranasal spray
2) variceal bleeding: 100 units in 250 mL D5W (0.4 I/mL) IV at 6-24 U/hour (15-60 mL/hour)
3) abdominal distension
a) 5 units IM stat
b) 10 units every 3-4 hours
Injection: 20 units/mL (1 mL)
Pharmacokinetics:
- elimination: liver, kidney
Adverse effects:
1) not common (1-10%)
- sweating, pounding in the head, hypertension, bradycardia, arrhythmias, venous thrombosis, vasoconstriction with higher doses, angina, tremor, vertigo, fever, urticaria, abdominal cramps, nausea/ vomiting, circumoral pallor, flatus
2) uncommon (< 1%)
- allergic reaction, myocardial infarction, water intoxication
Mechanism of action:
1) maintains serum osmolality by increasing passive resorption of water by the distal renal tubules
a) enables urine osmolality to reach 800-1200 mosm/kg
b) without ADH, urine osmolality reaches only 60-60 mosm/kg
2) causes vasoconstriction of the capillaries & small arterioles
3) release of ADH from the hypothalamus is stimulated by:
a) plasma osmolality > 280 mosm/kg
1] plasma ADH levels zero for osmolality < 280 mosm/kg
2] plasma ADH levels linearly related to osmolality for values > 280 mosm/kg
3] the organum vasculosum lamina terminalis is a chemoreceptor trigger zone in brain that senses osmolality
b) hypotension
c) decrease in plasma volume (7-10%)
d) decrease in effective plasma volume
1] cirrhosis
2] congestive heart failure
4) Pitressin elicits all of the pharmacologic responses of endogenous vasopressin
Related
arginine vasopressin (Argipressin, AVP)
desmopressin (deamino-arginine vasopressin, dDAVP, dDVP, Noctiva, Stimate, Minirin)
organum vasculosum lamina terminalis (OVLT)
osmolality (Osm)
prepro-vasopressin; vasopressin-neurophysin 2 copeptin (AVP)
vasopressin receptor antagonist (vaptan)
vasopressin receptor or antidiuretic hormone [ADH] receptor
General
vasopressin (antidiuretic hormone, ADH)
endocrine agent
gastrointestinal agent
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998