Vasopressin
The body's antidiuretic hormone, given by infusion in intensive care to raise blood pressure in shock that catecholamines cannot hold. Large trials found it safe beside norepinephrine but not life-saving; its price after a 2014 rebranding became part of its story.
Vasopressin is a nine-amino-acid peptide hormone. As Vasostrict it is approved to raise blood pressure in adults with vasodilatory shock who stay hypotensive despite fluids and catecholamines, infused at 0.01 to 0.07 units a minute in septic shock. Its apparent half-life at those rates is 10 minutes or less, so it only works as a continuous drip.
What is it?
Vasopressin is made in the hypothalamus and released from the posterior pituitary. In everyday physiology it tells the kidney to hold water; at higher levels it constricts blood vessels, which is why intensive-care units use it. PubMed returns about 51,300 records for it, most about the hormone's physiology rather than the drug. As a medicine it is Vasostrict, approved on April 17, 2014 (NDA 204485) to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines. Generic vasopressin followed from 2021, and a premixed bag in saline was approved in 2023.
Its role is as a second vasopressor. The label's septic-shock dose is 0.01 to 0.07 units a minute and its post-cardiotomy dose 0.03 to 0.1; at those rates clearance is 9 to 25 mL/min/kg and the apparent half-life 10 minutes or less, so it is given only as a continuous infusion. The largest trial, VASST, randomised 778 patients with septic shock already on norepinephrine to low-dose vasopressin (0.01 to 0.03 units a minute) or more norepinephrine: 28-day mortality was 35.4% against 39.3% (p = 0.26), 90-day mortality 43.9% against 49.6% (p = 0.11), with no difference in serious adverse events.
The trials since have told the same story. In 250 cancer patients with septic shock, vasopressin as first-line vasopressor gave 28-day mortality of 56.8% against 52.8% on norepinephrine (p = 0.52). An individual patient data meta-analysis of four trials and 1,453 patients found no effect on 28-day mortality (relative risk 0.98) or serious adverse events, more digital ischaemia (1.7 percentage points) and fewer arrhythmias (2.8 points), and a reduction in renal replacement therapy that did not survive sensitivity analyses. After cardiac surgery the picture was better: in 300 patients with vasoplegic shock, the combined rate of death or severe complications within 30 days was 32% on vasopressin against 49% on norepinephrine.
Outside shock it has older uses and recent disappointments. In 48 people with bleeding oesophageal varices, octreotide controlled bleeding at six hours in 88% against 54% on vasopressin, with fewer side effects such as headache, chest pain and abdominal pain (3 of 24 against 11 of 24). Given as a nasal spray in a large brain-imaging study, vasopressin and oxytocin had little effect on social cognition, adding to evidence that the early findings were overstated.
Cost became part of its history. When vasopressin was rebranded as Vasostrict in November 2014, its price rose steeply; in a database of 294,733 septic patients, the share receiving it was nevertheless higher afterwards (31.2% against 25.8%). Its label contraindicates the multidose vial in people allergic to arginine vasopressin or chlorobutanol, warns that in pregnancy it may cause tonic uterine contractions and that clearance rises in the second and third trimesters, and lists adverse reactions from the literature rather than trials. WADA's List does not name it; our Legal table explains its unsettled status.
Mechanism of Action
Vasopressin acts on its own receptors, not on the adrenergic receptors that norepinephrine uses. That independence is the reason it is added when catecholamines are failing.
Vasoconstriction
At infusion doses it constricts blood vessels and raised systemic vascular resistance in septic shock, cutting the norepinephrine needed (2006 trial).
Less norepinephrine, slower heart
In early septic shock it lowered heart rate and cardiac output while maintaining pressure in two-thirds of patients at 48 hours; one patient had an acute coronary syndrome.
Cleared in minutes
Proteases break it down quickly: the apparent half-life at shock doses is 10 minutes or less, so the effect stops soon after the infusion does (label).
Kidneys and arrhythmias
Pooled trials found fewer arrhythmias and a possible, fragile reduction in dialysis, but more digital ischaemia.
Published Research
PubMed returns about 51,300 records for vasopressin: the whole literature on the hormone, not a count of drug trials. Our evidence set holds 50 papers; 26 name it in their titles and have an abstract, and 7 are carded below: 6 studies in people and 1 individual patient data meta-analysis, chosen for the questions that decided how it is used.
VASST: vasopressin vs norepinephrine in septic shock, 778 patients
Patients already on at least 5 µg/min of norepinephrine received low-dose vasopressin (0.01 to 0.03 units/min) or more norepinephrine. Mortality at 28 days was 35.4% against 39.3% (p = 0.26) and at 90 days 43.9% against 49.6% (p = 0.11), with no difference in serious adverse events.
Vasoplegic shock after cardiac surgery, 300 patients
Patients were randomised to vasopressin (0.01 to 0.06 units/min) or norepinephrine (10 to 60 µg/min). Death or severe complications within 30 days occurred in 32% against 49%, and the authors concluded vasopressin can be a first-line vasopressor in this setting.
Cancer patients with septic shock, 250 patients
As first-line vasopressor, vasopressin gave 28-day mortality of 56.8% against 52.8% on norepinephrine (p = 0.52) and 90-day mortality of 72.0% against 75.2% (p = 0.56). It was not superior.
Individual patient data meta-analysis, 4 trials, 1,453 patients
Vasopressin had no effect on 28-day mortality (RR 0.98) or serious adverse events (RR 1.02). It caused more digital ischaemia (+1.7 points) and fewer arrhythmias (-2.8 points); a lower need for renal replacement therapy (RR 0.86) was not robust in sensitivity analyses.
Early hyperdynamic septic shock, 23 patients
Vasopressin alone (0.04 to 0.20 units/min) or norepinephrine for 48 hours raised mean arterial pressure equally, but 36% of vasopressin patients needed norepinephrine by 48 hours. Vasopressin raised vascular resistance, lowered heart rate and cardiac output and improved organ scores; one patient had an acute coronary syndrome.
Octreotide vs vasopressin for bleeding varices, 48 patients
Bleeding was controlled at six hours in 88% on octreotide against 54% on vasopressin (0.4 units/min; p = 0.03), and completely at 24 hours in 63% against 46%. Headache, chest pain and abdominal pain were less common with octreotide (3 of 24 against 11 of 24).
Use after the 2014 rebranding, 294,733 patients
In ICU patients with severe sepsis or septic shock on vasoactive drugs, 27.8% received vasopressin. Its cost rose steeply after the November 2014 rebranding, yet the share receiving it was higher afterwards (31.2% against 25.8%).
Dosing Data
Vasopressin is dosed by label as a continuous intravenous infusion, titrated to blood pressure by an intensive-care team.
Educational information, not medical advice. Each dose above is tagged with its source: an approved label, a published human study, animal data, or amounts reported by users. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose. Full medical disclaimer.
Side Effects & Contraindications
Reported Side Effects
From the Vasostrict label and the studies above.
Contraindications & Cautions
From the Vasostrict label; a clinician decides.
Legal Status
Vasopressin is an approved hospital medicine in the US. The sport row below comes from the dataset.
Frequently Asked Questions
?What is vasopressin used for?
As Vasostrict, it raises blood pressure in adults with vasodilatory shock, such as septic shock or shock after heart surgery, who stay hypotensive despite fluids and catecholamines. It is given as a continuous intravenous infusion in intensive care.
?Does vasopressin reduce deaths in septic shock?
Not in the trials. VASST found 28-day mortality of 35.4% against 39.3% on norepinephrine (p = 0.26), and a meta-analysis of 1,453 patients found no mortality effect (relative risk 0.98).
?Why is vasopressin given as a drip?
Because it is cleared in minutes: its apparent half-life at shock doses is 10 minutes or less (Vasostrict label).
?Why did vasopressin become expensive?
Its price rose steeply after it was rebranded as Vasostrict in November 2014; a study of 294,733 septic patients found use nonetheless increased. Generic versions were approved from 2021.
References
- [fda-pi] Vasostrict (vasopressin injection) Prescribing Information. Par Health USA (DailyMed, read 2026-09-28).
- [fda-pi] US FDA, Drugs@FDA: Vasostrict NDA 204485 (April 17, 2014); generic vasopressin ANDAs 2021-2023; vasopressin in sodium chloride NDA 217569 (September 29, 2023) (read 2026-09-28).
- [Human] Russell JA, et al. "Vasopressin versus norepinephrine infusion in patients with septic shock." N Engl J Med, 2008;358(9):877-87. PMID: 18305265.
- [Human] Hajjar LA, et al. "Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial." Anesthesiology, 2017;126(1):85-93. PMID: 27841822.
- [Human] Hajjar LA, et al. "Vasopressin Versus Norepinephrine for the Management of Septic Shock in Cancer Patients: The VANCS II Randomized Clinical Trial." Crit Care Med, 2019;47(12):1743-1750. PMID: 31609774.
- [Review] Nagendran M, et al. "Vasopressin in septic shock: an individual patient data meta-analysis of randomised controlled trials." Intensive Care Med, 2019;45(6):844-855. PMID: 31062052.
- [Human] Lauzier F, et al. "Vasopressin or norepinephrine in early hyperdynamic septic shock: a randomized clinical trial." Intensive Care Med, 2006;32(11):1782-9. PMID: 17019548.
- [Human] Hwang SJ, et al. "A randomized controlled trial comparing octreotide and vasopressin in the control of acute esophageal variceal bleeding." J Hepatol, 1992;16(3):320-5. PMID: 1487608.
- [Human] Sacha GL, et al. "Association Between Vasopressin Rebranding and Utilization in Patients With Septic Shock." Crit Care Med, 2022;50(4):644-654. PMID: 34605778.
- [guideline] Evans L, Rhodes A, Alhazzani W, et al. "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021." Crit Care Med, 2021;49(11):e1063-e1143.
Sources & Citations
Every PubMed citation on this page has been checked against its record. The Vasostrict label was read on DailyMed and approvals on Drugs@FDA on September 28, 2026. Grey Peptides sells nothing and links to no vendor.
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