Vasopressin (Vasostrict)_Dosage, benefits & legal status
Also known as Vasostrict, argipressin, arginine vasopressin, 8-L-arginine vasopressin, AVP, ADH, antidiuretic hormone, Pitressin, Empressin, Empressine, Reverpleg
The body's own 9-residue pituitary hormone that holds water and tightens blood vessels. Sold for nearly a century, it gained its first FDA approval for shock, as Vasostrict, on April 17, 2014.
Common vial size is what vendors typically sell, not a recommendation. Enter your own vial in the calculator.
What is Vasopressin (Vasostrict)?
Plain language first. The technical label stays, but it never stands alone.Overview
In septic shock and after heart surgery, blood vessels can relax so far that blood pressure stays dangerously low despite fluids and norepinephrine. Added by drip, vasopressin raises blood pressure and lowers the norepinephrine dose needed, but in VASST (778 patients with septic shock) deaths at 28 days were 35.4% against 39.3% with norepinephrine, a difference that could be chance. It can cut blood flow to the heart, gut, fingers and toes, so it is used only in intensive care.
Vasopressin (INN argipressin) is the natural nine-residue posterior pituitary hormone, Cys-Tyr-Phe-Gln-Asn-Cys-Pro-Arg-Gly-NH2, with a disulfide between cysteines 1 and 6. It tightens vascular smooth muscle through V1 receptors and holds water through kidney V2 receptors, raising blood pressure by a route separate from the catecholamines. Desmopressin is a modified analog that favors the kidney V2 receptor and has little pressor effect, while terlipressin is a prodrug of lysine vasopressin, the pig form with lysine at position 8, not of arginine vasopressin.
What it's used for
A continuous drip into a vein in intensive care, to raise blood pressure in adults with septic shock or shock after heart surgery that persists despite fluids and catecholamine drugs.
How does Vasopressin (Vasostrict) work?
What it does in the body, and where.Vasopressin is the body's own water-holding hormone, and at drip doses in shock it tightens blood vessels through a receptor that adrenaline-type drugs do not use.
- 01A different switchGiven as a continuous drip, it binds V1 receptors on the muscle of blood-vessel walls. That sets off a calcium signal that tightens the vessels, so blood pressure rises, peaking within 15 minutes; atosiban, used to delay preterm labor, mainly blocks oxytocin receptors in the womb and also blocks this V1a receptor.
- 02Working with norepinephrineBecause this route is separate from the receptors norepinephrine uses, the effects add up and the norepinephrine dose can come down. It tends to slow the heart and lower cardiac output, and its effect did not wear off with continued use. Angiotensin II, another hormone given by drip in shock, works through a third route, the AT1 receptor.
- 03Kidneys and switching offThrough V2 receptors in the kidney it holds water; when it is stopped, temporary diabetes insipidus can follow. Its half-life is 10 minutes or less, so changes to the drip show quickly. Desmopressin, a modified analog, acts mainly on V2 with little effect on blood pressure, and terlipressin (half-life about 0.9 hours) is converted in the body to lysine vasopressin, whose half-life is about 3 hours.
A schematic of the compound's mechanism, not a diagnostic image.
What else is it used for?
Each group carries its own evidence level.Approved means regulators have cleared it for that purpose. Investigational means it is in trials. Early research means it is being studied and is not established.
Septic shock (VASST)
FDA-approved- Human trial778 patients: 28-day mortality 35.4% against 39.3% with norepinephrine (P=0.26); 90-day mortality 43.9% against 49.6% (P=0.11).
- No dataLess severe shock: 26.5% against 35.7% (P=0.05); more severe shock: 44.0% against 42.5%. The strata were prespecified, but the test for a difference between them was not significant (P=0.10), and the FDA's 2014 review noted the finding had not been tested in a later prospective trial.
Early use and the kidneys (VANISH)
tested-and-failed- Human trial409 patients in 18 UK intensive care units: kidney failure-free days median 9 against 13 with norepinephrine (difference -4 days, 95% CI -11 to 5); never developed kidney failure 57.0% against 59.2%.
- Human trialRenal replacement therapy 25.4% against 35.3%, a secondary result; serious adverse events 10.7% against 8.3%.
After heart surgery (VANCS)
FDA-approved- Human trial300 patients with vasoplegic shock at one center: death or severe complications by day 30 in 32% against 49% with norepinephrine (HR 0.55, P=0.0014); atrial fibrillation 63.8% against 82.1%.
- No dataA 2013 conference abstract of the same trial reported different figures (major morbidity 23.5% against 34%, using a different outcome definition); the 2017 paper is the reference.
Cardiac arrest
tested-and-failed- Human trialOut of the hospital, 2,894 patients: adding vasopressin to epinephrine did not improve survival to discharge (1.7% against 2.3%) or at 1 year (1.3% against 2.1%).
- Human trialIn the hospital (VAM-IHCA, Andersen 2021), 501 patients: vasopressin with methylprednisolone raised return of circulation (42% against 33%) but not 30-day survival (9.7% against 12%).
Selepressin, a V1a-selective relative
tested-and-failed- Human trialSEPSIS-ACT, 868 patients with septic shock: ventilator- and vasopressor-free days 15.0 against 14.5 with placebo (P=.30) and 90-day mortality 40.6% against 39.4%; stopped for futility.
Vasostrict's approval is often dated November 2014, from Par's press release of November 12, 2014 announcing approval and shipping; the FDA approved NDA 204485 on April 17, 2014. 'First approved vasopressin' is loose: the hormone had older labeled uses for diabetes insipidus and Parke-Davis held an NDA for Pitressin Tannate, so Vasostrict was the first approval for intravenous use in shock. The first competitor, American Regent's 2020 product, was an NDA, not a generic; Eagle's ANDA of December 15, 2021 was the first generic. Endo's 2022 claim of the only ready-to-use vasopressin was true at the time, but Baxter and Long Grove have since won approval for ready-to-use vasopressin in saline. VASST is often cited as showing lower mortality, but its primary result (35.4% against 39.3%, P=0.26) was not significant, and only the less severe subgroup reached P=0.05. The label's septic-shock starting dose is 0.01 units/min; 0.03 units/min is the post-cardiotomy start and the top of the VASST range. The label half-life is 10 minutes or less, not 10 to 20 minutes. Terlipressin is reported as a vasopressin prodrug, but it is a prodrug of lysine vasopressin, not of arginine vasopressin, and desmopressin is a modified analog that acts on the kidney with little effect on blood pressure. Units per milligram differ between sources (530 units per mg in the US label; 20 IU per 66.5 micrograms of argipressin acetate in a Dutch label), so doses here are given only in units per minute.
The published record
Papers and trials about Vasopressin (Vasostrict)
403 papers tagged human · 246 not reviews or lab · 46 clinical trial publications
429 registered trials · 20 with posted results
Furthest stage reached: Approved in the US
Counted from Europe PMC indexing, not read by a person; a human tag can land on reviews, commentary or lab papers; clinical trial publications is the narrower count. 453 papers and 100 trials indexed in detail.
At a glance
Four things to know about Vasopressin (Vasostrict)
Evidence
FDA-approved
Category
Sexual and hormonal
Common vial
Varies
Half-life
10 minutes or less
How much, and do you cycle it?
The range, and whether you take breaks.0.01 to 0.07 units/min in septic shock, 0.03 to 0.1 units/min after heart surgery (label), continuous infusion, adjusted to blood pressure. Continuous until the shock resolves FDA label
Run continuously and adjusted every 10 to 15 minutes, then tapered by 0.005 units/min an hour once blood pressure has held for 8 hours without catecholamines.
How long does it stay in the body?
The half-life, and where the figure comes from.10 minutes or lessFDA label
The label gives an apparent half-life of 10 minutes or less at therapeutic levels, with clearance of 9 to 25 mL/min/kg in vasodilatory shock. It is mostly broken down by enzymes (serine protease, carboxypeptidase and disulfide oxidoreductase), and about 6% leaves unchanged in urine. Clearance rises about 4-fold by the third trimester and up to 5-fold at term. The pressor effect peaks within 15 minutes.
Source: Vasostrict US prescribing information, section 12.3
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How is it given?
Dosing context and source notes.Given in hospital from a prepared product, so there is nothing to mix.
Label range: 0.01 up to 0.1 units/min per dose. Vasostrict US prescribing information (openFDA, April 2026), section 2
Given only as a continuous infusion into a vein in intensive care. Septic shock: start at 0.01 units/min, range 0.01 to 0.07 units/min. Shock after heart surgery (post-cardiotomy): start at 0.03 units/min, range 0.03 to 0.1 units/min. Raise by 0.005 units/min every 10 to 15 minutes to the target blood pressure; after 8 hours at target without catecholamines, taper by 0.005 units/min every hour as tolerated. In the second and third trimesters the dose may need to be raised because clearance rises, about 4-fold by the third trimester and up to 5-fold at term; older adults start low. The label gives no kidney or liver adjustment; FDA reviewers noted the dose is titrated to effect. Vials (20 units/mL, or 200 units/10 mL with chlorobutanol) are diluted in saline or 5% dextrose, for example 50 units in 500 mL (0.1 units/mL), or 100 units in 100 mL (1 unit/mL) when fluids are restricted; premixed products in dextrose or saline are used as supplied. Diluted solution is discarded after 18 hours at room temperature or 24 hours refrigerated. Doses are in units, not milligrams, and are set by blood pressure minute to minute, so the calculator cannot produce a draw.
How do you store it?
Before mixing, and after.Given in a hospital or trial clinic, so the pharmacy stores it.
Vasopressin (Vasostrict) goes into a vein and is prepared by hospital, clinic or trial pharmacy staff, following the product label or the trial protocol. Some products like this are ready-made solutions and others are powders mixed just before use, often with hours rather than weeks of shelf life once prepared. It is not a medicine people store at home.
What are the side effects and cautions?
Known cautions and warnings for this compound.Solubility, computed: 33% charged residues, 44% hydrophobic. Water usually sufficient.
A first-pass rule from peptide manufacturers' guidance. It does not account for disulfide bridges, salt form or how the powder was dried, and it predicts what should be easy rather than what will happen in your vial.
Who should avoid it
- Allergy to 8-L-arginine vasopressin; the 10 mL multiple-dose vial is also contraindicated with allergy to its preservative, chlorobutanol
- Children: safety and effectiveness not established
- Pregnancy: it may cause sustained contractions of the womb that could threaten the pregnancy, and the second and third trimesters can need higher doses
- Catecholamines add to its effect; indomethacin may prolong it; ganglionic blockers and drugs that cause SIADH may strengthen it, and drugs that cause diabetes insipidus may weaken it
Stop and get help
- Signs of poor blood flow: chest pain, severe abdominal pain, or cold, pale or darkening fingers, toes or skin
- A falling cardiac output or a new slow or irregular heartbeat: the infusion is turned down, and the effect fades within minutes
Common effects
- VASST, 778 patients with septic shock: serious adverse events 10.3% against 10.5% with norepinephrine (P=1.00)
- VANISH, 409 patients: serious adverse events 10.7% (22 of 205) against 8.3% (17 of 204)
- VANCS, 300 patients after heart surgery: atrial fibrillation 63.8% against 82.1% with norepinephrine, with no difference in finger, toe or gut ischemia, low sodium or heart attack
- The label lists, without rates, decreased cardiac output, slow heartbeat, fast irregular rhythms, low sodium and ischemia of the heart, gut, skin and fingers or toes
Where this page says nothing is established, that means nobody has studied it, not that a compound is safe.
Is Vasopressin (Vasostrict) approved?
And where the numbers on this page come from.Yes. Vasopressin (Vasostrict) is FDA approved and available on prescription in the United States. It is also approved in the Netherlands and France.
- Approval statusFDA-approved
- RouteInto a vein (continuous infusion)
- Checked21 October 2026
- Approved outside the USNetherlands, France: Authorized nationally in Europe as argipressin, including Empressine 20 IU/mL (Orpha-Devel) in the Netherlands since June 4, 2018 for low blood pressure after septic shock that persists despite catecholamines, and Reverpleg 40 IU/2 mL in France, where the HAS rated its clinical benefit moderate and its added value as none (ASMR V). Also approved in the US.This does not change the United States position above.
- DoseFrom the drug label. The manufacturer tested this range and a regulator reviewed it.
- Vial sizeFrom what vendors typically list; not a recommendation.
- SourcesVasostrict US prescribing information (openFDA label record, April 2026)Drugs@FDA, NDA 204485 (Vasostrict)FDA summary review, NDA 204485 (2014)openFDA Drugs@FDA, all vasopressin applicationsFDA GSRS substance record, vasopressin (UNII Y4907O6MFD)Russell JA et al., New England Journal of Medicine 2008;358:877-887 (VASST)Gordon AC et al., JAMA 2016;316:509-518 (VANISH)Hajjar LA et al., Anesthesiology 2017;126:85-93 (VANCS)Andersen LW et al., JAMA 2021 (VAM-IHCA)Gueugniaud PY et al., New England Journal of Medicine 2008;359:21-30Wenzel V et al., New England Journal of Medicine 2004;350:105-113Laterre PF et al., JAMA 2019;322:1476-1485 (SEPSIS-ACT, selepressin)Eagle Pharmaceuticals, first generic vasopressin approval (SEC exhibit, December 15, 2021)Empressine 20 IU/mL summary of product characteristics (Netherlands)
What has happened recently
Vasopressin has been marketed in the US for nearly a century, labeled for injection into muscle or under the skin for central diabetes insipidus and for abdominal distention after surgery and abdominal X-rays; intravenous use in shock was unapproved, and Parke-Davis's Pitressin Tannate (NDA 003402) is discontinued. The FDA launched its unapproved drugs initiative in June 2006; JHP Pharmaceuticals filed a 505(b)(2) application based on published literature on September 25, 2012, received a Complete Response on July 19, 2013, mainly for product-quality issues, and resubmitted on October 18, 2013; Par bought JHP in February 2014, and the FDA approved Vasostrict (NDA 204485) on April 17, 2014 as a drug already marketed without an approved NDA, with no advisory committee. A reversible diabetes insipidus warning was added on February 21, 2020, and Endo launched premixed, ready-to-use Vasostrict in dextrose on February 7, 2022. Competitors followed: American Regent's NDA 212593 on August 3, 2020; Eagle's ANDA, the first generic, on December 15, 2021, alongside a court ruling of no patent infringement; a Dr. Reddy's authorized generic from February 9, 2022; generics from Amphastar, Amneal, Eugia, Fresenius Kabi, Cipla, Gland, Dr. Reddy's and Sandoz between 2022 and May 6, 2026; and ready-to-use vasopressin in saline from Baxter (September 29, 2023) and Long Grove (July 11, 2024).
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What else is like Vasopressin (Vasostrict)?
Others in Sexual and hormonal, side by side.If you're weighing Vasopressin (Vasostrict), it's worth reading PT-141 (Bremelanotide), Kisspeptin, and Oxytocin in the same class.
The body's own 9-residue pituitary hormone that holds water and tightens blood vessels. Sold for nearly a century, it gained its first FDA approval for shock, as Vasostrict, on April 17, 2014.
- Dose
- 0.01 to 0.07 units/min in septic shock, 0.03 to 0.1 units/min after heart surgery (label)
- How often
- Continuous infusion, adjusted to blood pressure
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- Dose
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- How often
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Guides for this compound
- How to Reconstitute a Peptide
Mix peptide powder with bacteriostatic water, step by step.
- How to Read an Insulin Syringe
Read the units, convert to millilitres, and draw the exact dose.
- mcg vs mg: The Peptide Dosing Mistake to Avoid
Your vial says mg and your protocol says mcg. Here is the conversion and how to check it.
Sources
- Vasostrict US prescribing information (openFDA label record, April 2026)(2026)Indication; septic and post-cardiotomy dosing; half-life 10 minutes or less; warnings on heart function and reversible diabetes insipidus; current vials and premixes.
- Drugs@FDA, NDA 204485 (Vasostrict)(2023)Approved April 17, 2014 as a drug already marketed without an approved NDA; diabetes insipidus warning added February 21, 2020; 50 units/50 mL vial added April 12, 2023.
- FDA summary review, NDA 204485 (2014)(2014)Marketed for nearly a century; approval based on published studies of blood pressure; Complete Response July 19, 2013; Par's purchase of JHP in February 2014.
- openFDA Drugs@FDA, all vasopressin applications(2026)16 applications, including American Regent (August 3, 2020), Eagle (December 15, 2021), Baxter (September 29, 2023), Long Grove (July 11, 2024) and Sandoz (May 6, 2026).
- FDA GSRS substance record, vasopressin (UNII Y4907O6MFD)(2026)CYFQNCPRG with a disulfide between positions 1 and 6; CAS 113-79-1; INN argipressin.
- Russell JA et al., New England Journal of Medicine 2008;358:877-887 (VASST)(2008)778 patients with septic shock: 28-day mortality 35.4% against 39.3% with norepinephrine (P=0.26); less severe shock 26.5% against 35.7% (P=0.05).
- Gordon AC et al., JAMA 2016;316:509-518 (VANISH)(2016)409 patients: kidney failure-free days median 9 against 13, not significant; renal replacement therapy 25.4% against 35.3%.
- Hajjar LA et al., Anesthesiology 2017;126:85-93 (VANCS)(2017)300 treated after heart surgery: death or severe complications 32% against 49% (HR 0.55, P=0.0014); atrial fibrillation 63.8% against 82.1%.
- Andersen LW et al., JAMA 2021 (VAM-IHCA)(2021)501 in-hospital cardiac arrests: return of circulation 42% against 33% with placebo; 30-day survival 9.7% against 12%, not significant.
- Gueugniaud PY et al., New England Journal of Medicine 2008;359:21-30(2008)2,894 out-of-hospital arrests: vasopressin plus epinephrine against epinephrine alone, survival to admission 20.7% against 21.3% and to discharge 1.7% against 2.3%.
- Wenzel V et al., New England Journal of Medicine 2004;350:105-113(2004)1,186 out-of-hospital arrests against epinephrine: hospital admission similar in ventricular fibrillation (46.2% against 43.0%) and electrical activity without a pulse, higher in asystole (29.0% against 20.3%).
- Laterre PF et al., JAMA 2019;322:1476-1485 (SEPSIS-ACT, selepressin)(2019)868 patients: ventilator- and vasopressor-free days 15.0 against 14.5 with placebo (P=.30); stopped for futility.
- Eagle Pharmaceuticals, first generic vasopressin approval (SEC exhibit, December 15, 2021)(2021)First ANDA approval; court found no infringement of Par's patents; Vasostrict US sales $786 million in 2020.
- Empressine 20 IU/mL summary of product characteristics (Netherlands)(2026)First authorized June 4, 2018 for hypotension after septic shock that persists despite catecholamines; 0.01 to 0.03 IU/min; half-life under 10 minutes.
Beyond these, 553 records are indexed. Browse the records