Pitressin Side Effects

Generic Name: vasopressin

Note: This page contains side effects data for the generic drug vasopressin. It is possible that some of the dosage forms included below may not apply to the brand name Pitressin.

It is possible that some side effects of Pitressin may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to vasopressin: injection solution

As well as its needed effects, vasopressin (the active ingredient contained in Pitressin) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking vasopressin, check with your doctor immediately:

Rare
  • Chest pain
  • coma
  • confusion
  • convulsions (seizures)
  • drowsiness
  • fever
  • headache that continues
  • problems with urination
  • redness of skin
  • skin rash, hives, or itching
  • swelling of face, feet, hands, or mouth
  • weight gain
  • wheezing or trouble with breathing

Some vasopressin side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Less common
  • Abdominal or stomach cramps
  • belching
  • diarrhea
  • dizziness or lightheadedness
  • increased sweating
  • increased urge for a bowel movement
  • nausea or vomiting
  • pale skin
  • passage of gas
  • "pounding'' in head
  • trembling
  • white-colored area around the mouth

For Healthcare Professionals

Applies to vasopressin: injectable solution

Cardiovascular

Cardiovascular side effects have included cardiac arrest, circumoral pallor, decreased cardiac output, increased blood pressure, bradycardia, arrhythmias, venous thrombosis, myocardial ischemia, peripheral vasoconstriction at higher doses, and angina. The overall incidence of cardiovascular complications has been estimated to be 25%.[Ref]

Due to vasopressin-induced increased coronary and systemic vascular resistance, the drug can cause myocardial ischemia, reduced cardiac output, and systemic hypertension. Some clinicians choose to give nitroglycerin and/or isoproterenol during vasopressin administration to reduce the likelihood of some of these problems.

Cardiovascular side effects related to the pressor activity of vasopressin may be important in patients with a history of coronary artery or peripheral vascular disease. The vascular beds most affected (in decreasing order) are iliac, mesenteric, coronary, and renal. Cardiac arrest, circumoral pallor, arrhythmias (usually bradycardia; rarely torsades de pointes), decreased cardiac output, angina pectoris, myocardial ischemia, peripheral vasoconstriction and gangrene have been reported. Intoxication may result in water retention and/or hyponatremia, which can be effectively treated by withholding therapy and water restriction.[Ref]

Dermatologic

Dermatologic side effects of severe vasopressin-induced peripheral vasoconstriction have included sweating, alopecia, cutaneous necrosis or infarcts, and gangrene. These problems were more likely at the site of administration.[Ref]

While cutaneous necrosis has most commonly been associated with extravasation at or proximal to IV catheter sites, several cases of necrosis have been reported at sites distant from direct IV flow.

Rare cases of subcutaneous calcifications have been associated with the use of pitressin tannate, an oil-based injectable product, which is no longer marketed in the US.[Ref]

Hypersensitivity

Diabetes insipidus does not result from spontaneously occurring antibodies to vasopressin (the active ingredient contained in Pitressin) Such antibodies can develop during treatment with vasopressin, however, and can cause resistance to its diuretic effect.[Ref]

Hypersensitivity side effects have included rare cases of severe anaphylaxis and urticaria.[Ref]

Gastrointestinal

Mesenteric artery thrombosis (MAT) with retrograde propagation of the thrombus into the portal vein has been associated with selective arterial drug infusions for control of upper gastrointestinal hemorrhage. In some cases, small bowel necrosis with or without bacterial peritonitis secondary to thrombosis of the superior mesenteric artery has resulted. Because up to 10% of patients with liver cirrhosis develop portal vein thrombosis, an association between intra-arterial vasopressin (the active ingredient contained in Pitressin) and MAT may be coincidental.[Ref]

Gastrointestinal side effects have included abdominal cramps, nausea, vomiting, diarrhea, and flatus in 18% of patients. Unexplained abdominal pain associated with hemodynamic instability in patients receiving vasopressin has rarely been associated with mesenteric or portal vein thrombosis and bowel necrosis.[Ref]

Renal

Renal side effects have included reports of myoglobinuria with acute renal failure, which has been attributed to vasopressin-induced skeletal muscle ischemia in two patients.[Ref]

Nervous system

Nervous system side effects have included tremor, vertigo, and headache (usually described as a "pounding head").[Ref]

Respiratory

Respiratory side effects have included rare cases of bronchial constriction, pulmonary edema, and adult respiratory distress syndrome (ARDS).[Ref]

References

1. Klein GJ "Vasopressin, "torsades de pointes," and QT syndrome." Ann Intern Med 93 (1980): 511-2

2. Khokhar AM, Slater JD, Ma J, Ramage CM "The cardiovascular effect of vasopressin in relation to its plasma concentration in man and its relevance to high blood pressure." Clin Endocrinol (Oxf) 13 (1980): 259-66

3. Zelch MG, Geisinger MA, Risius B "Tongue necrosis after intraarterial vasopressin therapy." AJR Am J Roentgenol 144 (1985): 1283-4

4. Brearley S, Hawker PC, Dykes PW, Keighley MR "A lethal complication of peripheral vein vasopressin infusion." Hepatogastroenterology 32 (1985): 224-5

5. Mauro VF, Bingle JF, Ginn SM, Jafri FM "Torsade de pointes in a patient receiving intravenous vasopressin." Crit Care Med 16 (1988): 200-1

6. Saari A, Klvilaakso E, Inberg M, Paakkonen M, Lahtinen J, Hockerstedt K, Schroder T "Comparison of somatostatin and vasopressin in bleeding esophageal varices." Am J Gastroenterol 85 (1990): 804-7

7. Eden E, Teirstein A, Wiener I "Ventricular arrhythmia induced by vasopressin: torsade de pointes related to vasopressin-induced bradycardia." Mt Sinai J Med 50 (1983): 49-51

8. Kelly KJ, Stang JM, Mekhjian HS "Vasopressin provocation of ventricular dysrhythmia." Ann Intern Med 92 (1980): 205-6

9. Moreno-Sanchez D, Casis B, Martin A, Ortiz P, Castellano G, Munoz MT, Vanaclocha F, Solis-Herruzo JA "Rhabdomyolysis and cutaneous necrosis following intravenous vasopressin infusion." Gastroenterology 101 (1991): 529-32

10. Beller BM, Trevino A, Urban E "Pitressin-induced myocardial injury and depression in a young woman." Am J Med 51 (1971): 675-9

11. "Product Information. Pitressin (vasopressin)." Parke-Davis, Morris Plains, NJ.

12. Blei AT "Pharmacology of portal hypertension: old problems and new ideas." JAMA 247 (1982): 669-70

13. Stein LB, Dabezies MA, Silverman M, Brozena SC "Fatal torsade de pointes occurring in a patient receiving intravenous vasopressin and nitroglycerin." J Clin Gastroenterol 15 (1992): 171-4

14. Greenwald RA, Rheingold OJ, Chiprut RO, Rogers AI "Local gangrene: a complication of peripheral Pitressin therapy for bleeding esophageal varices." Gastroenterology 74 (1978): 744-6

15. Bohnen N, Twijnstra A, Terwel D, Jolles J "Inverse relationship between plasma vasopressin and intracranial pressure." Horm Metab Res 24 (1992): 141-2

16. Fitz JD "Vasopressin induction of ventricular ectopy." Arch Intern Med 142 (1982): 644

17. Colombani P "Upper extremity gangrene secondary to superior mesenteric artery infusion of vasopressin." Dig Dis Sci 27 (1982): 367-9

18. Mogan GR, Wormser GP, Gottfried EB "Infected gangrene. A serious complication of peripheral vasopressin administration." Am J Gastroenterol 73 (1980): 426-9

19. Jacoby AG, Wiegman MV "Cardiovascular complications of intravenous vasopressin therapy." Focus Crit Care 17 (1990): 63-6

20. Stump DL, Hardin TC "The use of vasopressin in the treatment of upper gastrointestinal haemorrhage." Drugs 39 (1990): 38-53

21. Twiford TW Jr, Granmayeh M, Tucker MJ "Gangrene of the feet associated with mesenteric intraarterial vasopressin." AJR Am J Roentgenol 130 (1978): 558-60

22. Borgeat A, Popovic V, Nicole A, Schwander D "Acute pulmonary oedema following administration of ornithine-8- vasopressin." Br J Anaesth 65 (1990): 548-51

23. Schweitzer EJ, Kerr JC, Swan KG "Clinical use of vasopressin in the management of bleeding esophageal varices." Am Surg 48 (1982): 558-62

24. Sherman LM, Shenoy SS, Cerra FB "Selective intra-arterial vasopressin: clinical efficacy and complications." Ann Surg 189 (1979): 298-302

25. Butow KW, de Witt TW, Jacobs FJ "Ornithine-vasopressin gangrene and reconstruction of the upper lip. Case report." J Craniomaxillofac Surg 17 (1989): 88-91

26. Sirinek KR, Thomford NR "Isoproterenol in offsetting adverse effects of vasopressin in cirrhotic patients." Am J Surg 129 (1975): 130-6

27. Pierce ST, Nickl N "Rhabdomyolysis associated with the use of intravenous vasopressin." Am J Gastroenterol 88 (1993): 424-7

28. Reddy KR, Iskandarani M, Jeffers L, Schiff ER "Bilateral nipple necrosis after intravenous vasopressin therapy." Arch Intern Med 144 (1984): 835-6

29. Korenberg RJ, Landau-Price D, Penneys NS "Vasopressin-induced bullous disease and cutaneous necrosis." J Am Acad Dermatol 15 (1986): 393-8

30. Wormser GP, Kornblee LV, Gottfried EB "Cutaneous necrosis following peripheral intravenous vasopressin therapy." Cutis 29 (1982): 249-52

31. Adam A, Rakhit G, Beeton S, Mitchenere P "Extensive subcutaneous calcification following injections of pitressin tannate." Br J Radiol 57 (1984): 921-2

32. Thomas TK "Cutaneous manifestations of intravenous vasopressin therapy." Am J Gastroenterol 80 (1985): 704-5

33. Maceyko RF, Vidimos AT, Steck WD "Vasopressin-associated cutaneous infarcts, alopecia, and neuropathy." J Am Acad Dermatol 31 (1994): 111-3

34. Chang FY, Cheng JT, Lai KH, Lee SD, Tsai YT "Scrotal ischemia after intravenous vasopressin therapy for hemorrhagic esophageal varices." N Y State J Med 89 (1989): 583-4

35. Gogel HK, Sherman RW, Becker LE "Scrotal and abdominal skin necrosis complicating intravenous vasopressin therapy for bleeding esophageal varices." Dig Dis Sci 30 (1985): 460-4

36. Vokes TJ, Gaskill MB, Robertson GL "Antibodies to vasopressin in patients with diabetes insipidus. Implications for diagnosis and therapy." Ann Intern Med 108 (1988): 190-5

37. Lawrence GD, Hsu TH, Lichtenstein LM "Diabetes insipidus with hypersensitivity to pitressin. An immunological study." Johns Hopkins Med J 131 (1972): 172-7

38. Lambert M, de Peyer R, Muller AF "Reversible ischemic colitis after intravenous vasopressin therapy." JAMA 247 (1982): 666-7

39. Bar-Meir S, Conn HO "Spontaneous bacterial peritonitis induced by intraarterial vasopressin therapy." Gastroenterology 70 (1976): 418-21

40. Gimson AE, Westaby D, Hegarty J, Watson A, Williams R "A randomized trial of vasopressin and vasopressin plus nitroglycerin in the control of acute variceal hemorrhage." Hepatology 6 (1986): 410-3

41. Snady H "Acute portal vein thrombosis, sclerotherapy, and vasopressin: relationships and implications." Am J Gastroenterol 82 (1987): 1292

42. Goldberg H, Fabry TL "Mesenteric thrombosis following sclerotherapy during vasopressin infusion: mechanism and therapeutic implications." J Clin Gastroenterol 11 (1989): 56-7

43. Stoltenberg PH, Goodale RL, Silvis SE "Portal vein thrombosis following combined endoscopic variceal sclerosis and vasopressin therapy for bleeding varices." Am J Gastroenterol 82 (1987): 1297-300

44. Renert WA, Button KF, Fuld SL, Casarella WJ "Mesenteric venous thrombosis and small-bowel infarction following infusion of vasopressin into the superior mesenteric artery." Radiology 102 (1972): 299-302

45. Berardi RS "Vascular complications of superior mesenteric artery infusion with pitressin in treatment of bleeding esophageal varices." Am J Surg 127 (1974): 757-61

46. Affarah HB, Mars RL, Someren A, Smith HW 3d, Heymsfield SB "Myoglobinuria and acute renal failure associated with intravenous vasopressin infusion." South Med J 77 (1984): 918-21

47. Lin TW, Kuo YS "Acute pulmonary oedema following administration of vasopressin for control of massive GI tract haemorrhage in a major burn patient." Burns 22 (1996): 73-5

48. Tulandi T, Beique F, Kimia M "Pulmonary edema: a complication of local injection of vasopressin at laparoscopy." Fertil Steril 66 (1996): 478-80

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