Download Vasopressin - Nottingham University Hospitals NHS Trust

Paediatric Critical Care Unit
Pharmacopoeia
Vasopressin
(8-Arginine Vasopressin, Argipressin)
Presentation:
Pitressin® Solution for injection 20 units/ml, 1ml vials.
Stored in fridge.
Indications:
Vasoconstriction in vasodilatory shock, in addition to intravenous catecholamines.
Start at 0.0001 unit/kg/min and increase in increments of 0.0001 unit/kg/min as required,
up to a maximum of 0.001 unit/kg/min.
Dose:
Higher rates may occasionally be necessary: this should only be with consultant approval.
**Do not use for more than 48 hours as tachyphylaxis may occur.**
Route of
administration:
Central intravenous infusion ONLY. Minimum concentration 0.1 unit in mL; maximum
concentration 1 unit in 1 mL.
Amount of drug
Patient
to add to 50 mL
weight
syringe
Directions for
Administration:
Under
8kg
Dilute to 50mL
With
1 mL/hr =
Dose range
Dilute 5units to 50mL with sodium chloride 0.9% or glucose 5%. 1ml/hr will be
equivalent to x unit/kg/min, where x = 0.00167 divided by patient’s weight in kg.
8 – 16
kg
0.6 units
x weight (kg)
Over
16 kg
0.3 units
x weight (kg)
Sodium chloride
0.9%
or
glucose 5%
0.0002
unit/kg/min
0.0001– 0.001 unit/kg/min
0.0001
unit/kg/min
0.0001– 0.001 unit/kg/min
(0.5 – 5 mL/hr)
(1 – 10 mL/hr)
Contraindicated in chronic nephritis and vascular disease (esp. of coronary arteries),
unless with extreme caution. Extreme caution in cardiogenic shock. Caution in
Cautions and
ischaemic necrosis, heart failure, hypertension, asthma, epilepsy, migraine or other
Contraindications: conditions which might be aggravated by water retention; avoid fluid overload. Monitor
closely for signs of anginal pain or skin ischaemia. Monitor fluid balance, urine and
serum sodium and osmolality.
Higher doses may cause gut and skin ischaemia. Cardiac dysrhythmias, bradycardia,
Common
fluid retention, hyponatraemia, pallor, tremor, sweating, vertigo, headache, nausea,
Side Effects:
vomiting, hypersensitivity reactions, constriction of coronary arteries, bronchial
constriction, venous thrombosis.
Compatible
Incompatible
6
6
6
Adrenaline
Heparin sodium
Noradrenaline
Furosemide5, 6
Compatibility
Dobutamine5, 6
Insulin (soluble) 6
Sodium bicarbonate6
(Y – site):
5, 6
6
Dopamine
Lidocaine
Glyceryl trinitrate6
Milrinone6
1 milliunit = 0.001 unit. 1 unit = 1000 milliunits
Additional
Comments:
Vasopressin effect potentiated by: carbamazepine, urea, fludrocortisone, and tricyclic
antidepressants. Vasopressin effect reduced by heparin.
Vasopressor effect via vasopressin-1 receptor.
Extravasation is likely to cause tissue damage due to acidic pH (3.6)
Version 3, December 2015, Review December 2017.
Checked: Andrew Wignell, PICU Pharmacist; Amy-Jo Hooley, Specialist Paediatric Pharmacist
Approved: PICU Consultants.
Paediatric Critical Care Unit
Pharmacopoeia
References
nd
1. Medicines for Children, 2 Edition, 2003.
2. Guy’s and Thomas’ (Evelina) Paediatric Formulary, accessed via
http://www.evelinalondon.nhs.uk/our-services/hospital/pharmacy/formulary.aspx (accessed on
5/12/15)
3. Drug doses, Frank Shann: accessed via http://ww2.rch.org.au/clinicalguide/forms/drugDoses.cfm
(accessed 5/12/15).
4. Paediatric Injectable Drugs: accessed via http://www.medicinescomplete.com/mc/ (accessed
5/12/15).
rd
5. University College Hospitals Injectable Medicines Administration Guide, 3 Edition, 2010.
6. Paediatric and Neonatal Dosage Handbook, LexiComp; accessed via www.uptodate.com (accessed
5/12/15).
7. Trissel LA (ed), Handbook on Injectable Drugs. [online] London: Pharmaceutical Press accessed via
www.medicinescomplete.com (accessed on 08/07/2015).
Version 3, December 2015, Review December 2017.
Checked: Andrew Wignell, PICU Pharmacist; Amy-Jo Hooley, Specialist Paediatric Pharmacist
Approved: PICU Consultants.