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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.