Vasopressin Side Effects

Please note - some side effects for Vasopressin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects by Body System

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%.

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.

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.

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.

Hypersensitivity

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

Diabetes insipidus does not result from spontaneously occurring antibodies to vasopressin. Such antibodies can develop during treatment with vasopressin, however, and can cause resistance to its diuretic effect.

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 and MAT may be coincidental.

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.

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.

Nervous system

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

Respiratory

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

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