Classifications: PITUITARY HORMONE; ANTIDIURETIC HORMONE (ADH)
Therapeutic: ADH REPLACEMENT
ACTION & THERAPEUTIC EFFECT
Polypeptide hormone extracted from animal
posterior pituitaries, and possesses pressor and antidiuretic (ADH) properties.
Produces concentrated urine by increasing tubular reabsorption of water (ADH
activity), thus reabsorbing up to 90% of water in renal tubules. Causes
contraction of smooth muscles of the GI tract as well as the vascular system, especially
capillaries, arterioles and venules. Effective in reversing dieresis caused
by diabetes insipidus. When given intravenously, it is effective as an adjunct
in treating massive GI bleeding.
Antidiuretic to treat diabetes insipidus, to
dispel gas shadows in abdominal roentgenography, and as prevention and
treatment of postoperative abdominal distention.
Test for differential diagnosis of nephrogenic, psychogenic,
and neurohypophyseal diabetes insipidus; test to elevate ability of kidney to
concentrate urine, and provocative test for pituitary release of corticotrophin
and growth hormone; emergency and adjunct pressor agent in the control of
massive GI hemorrhage (e.g., esophageal varices).
Chronic nephritis accompanied by nitrogen retention;
ischemic heart disease, PVCs, advanced arteriosclerosis; lactation.
Epilepsy; migraine; asthma; heart failure,
angina pectoris; any state in which rapid addition to extracellular fluid may be
hazardous; vascular disease; preoperative and postoperative polyuric patients,
kidney disease; goiter with cardiac complications; older adult patients, labor
and delivery, pregnancy (category C), children.
Adult: IM/Subcutaneous 5–10 units aqueous solution 2–4 × day (5–60 units/day) or 1.25–2.5 units in oil q2–3days
Intranasal Apply to cotton pledget or intranasal spray
Child: IM/Subcutaneous 2.5–10 units aqueous solution 2–4 × day
Abdominal Distention, Abdominal Radiographic Procedures
Adult: IM/Subcutaneous 5 units with 5–10 units q3–4h prn or 5–15 units 2 h and 30 min
prior to procedure
Adult: IV 20 units bolus then 0.2–0.4 units/min up to 0.9 units/min
Intramuscular/Subcutaneous
- Give 1–2 glasses of water with vasopressin to reduce adverse
effects such as skin blanching, abdominal cramps and nausea.
- Give IM injection deeply into a large muscle.
- With subcutaneous injection, exercise caution not to inject
intradermally.
PREPARE: Direct/IV Infusion:
Dilute with NS or D5W to a concentration of 0.1–1
units/mL.
- Ensure patency prior to injection or infusion as extravasation may
cause severe vasoconstriction with tissue necrosis and gangrene.
ADVERSE EFFECTS (≥1%) Skin:
Rash, urticaria. Body as a Whole: Anaphylaxis;
tremor, sweating, bronchoconstriction, circumoral and facial pallor, angioneurotic
edema, pounding in head, water intoxication (especially with tannate), gangrene
at injection site with intraarterial infusion. GI: Eructations, passage
of gas, nausea, vomiting, heartburn, abdominal cramps, increased bowel
movements secondary to excessive use. CV: Angina (in patient with
coronary vascular disease); cardiac arrest, hypertension, bradycardia, minor
arrhythmias, premature atrial contraction, heart block, peripheral vascular
collapse, coronary insufficiency, MI; cardiac arrhythmia, pulmonary edema,
bradycardia (with intraarterial infusion). Urogenital: Uterine cramps. Respiratory:
Congestion, rhinorrhea, irritation, mucosal ulceration and pruritus,
postnasal drip. Special Senses: Conjunctivitis.
DIAGNOSTIC TEST INTERFERENCE
Vasopressin increases plasma cortisol levels.
Drug: Alcohol, demeclocycline, epinephrine, heparin,
lithium, phenytoin may decrease antidiuretic
effects of vasopressin; guanethidine, neostigmine increase vasopressor
actions; chlorpropamide, clofibrate, carbamazepine, THIAZIDE DIURETICS may
increase antidiuretic activity.
Duration: 2–8 h in aqueous
solution, 48–72 h in oil, 30–60 min IV infusion. Distribution: Extracellular
fluid. Metabolism: In liver and kidneys. Elimination: In urine. Half-Life:
10–20 min.
Assessment & Drug Effects
- Monitor infants and children closely. They are more susceptible to
volume disturbances (such as sudden reversal of polyuria) than adults.
- Establish baseline data of BP, weight, I&O pattern and ratio. Monitor
BP and weight throughout therapy. (Dose used to stimulate diuresis has little
effect on BP.) Report sudden changes in pattern to prescriber.
- Be alert to the fact that even small doses of vasopressin may precipitate
MI or coronary insufficiency, especially in older adult patients. Keep
emergency equipment and drugs (antiarrhythmics) readily available.
- Check patient’s alertness and orientation frequently during therapy.
Lethargy and confusion associated with headache may signal onset of
water intoxication, which, although insidious in rate of development, can lead to convulsions and
terminal coma.
- Monitor urine output, specific gravity, and serum osmolality while
patient is hospitalized.
- Withhold vasopressin, restrict fluid intake, and notify prescriber
if urine-specific gravity is less than 1.015.
Patient & Family Education
- Be prepared for possibility of angina attack and have coronary vasodilator
available (e.g., nitroglycerin) if there is a history of coronary artery
disease. Report to prescriber.
- With diabetes insipidus, measure and record data related to
polydipsia and polyuria. Keep an accurate record of output. Understand that treatment
should diminish intense thirst and restore undisturbed normal sleep.
- Avoid concentrated fluids (e.g., undiluted syrups), since these
increase urine volume.
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