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Peptide

Vasopressin (Vasostrict/Pitressin)

Vasopressin (arginine vasopressin, AVP) is a nonapeptide hormone. FDA-approved in 2014 for vasodilatory shock (septic shock, post-cardiotomy). VASST trial (NEJM 2008, n=778) showed mortality benefit in less severe septic shock (26.5% vs 35.7%, p=0.05). Allows reducing norepinephrine requirements. Dose: 0.01-0.1 units/minute. Surviving Sepsis Campaign recommends adding AVP when NE ≥0.25-0.50 µg/kg/min.

Research notice. This page is for education and research. Peptides may not be FDA-approved for human use and may only be legally available for research. Talk to a qualified clinician before considering any peptide.

Best evidence
Grade A
Conditions studied
1
Outcomes
10
Graded outcomes
4051

Evidence by condition

  • Strong
  • Moderate
  • Limited
  • Very limited

1 condition, plus general outcomes

Vasodilatory Shock

Vasodilatory Shock: outcomes studied for Vasopressin (Vasostrict/Pitressin)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Mortality (Less Severe Sepsis)

VASST trial: 28-day mortality 26.5% vs 35.7% (p=0.05) in less severe septic shock. No benefit in more severe shock.

Improves (the measure goes down)Moderate effect15 studies

Studies that measured mortality (less severe sepsis)

and 5 more in the citations list

Norepinephrine Sparing

Significantly reduces norepinephrine dose requirements at 24 and 48 hours. Allows weaning of catecholamines.

Improves (the measure goes down)Large effect11 studies

Studies that measured norepinephrine sparing

and 1 more in the citations list

Blood Pressure Support

FDA-approved for maintaining blood pressure in vasodilatory shock. MAP significantly higher at 24h with AVP+NE vs NE alone.

Improves (the measure goes up)Large effect10 studies

Studies that measured blood pressure support

Hemodynamic Stabilization

Heart rate lower at 24-48h with AVP. Effective even in catecholamine-resistant vasodilatory shock.

Improves (the measure goes up)Large effect10 studies

Studies that measured hemodynamic stabilization

General

General: outcomes studied for Vasopressin (Vasostrict/Pitressin)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Blood Glucose Control

10 systematic reviews and preclinical studies support this finding. Evidence includes systematic reviews/meta-analyses. Primarily preclinical evidence.

Improves (the measure goes down)Moderate effect13 studies

Studies that measured blood glucose control

and 3 more in the citations list

Kidney Function

7 systematic reviews and preclinical studies support this finding. Evidence includes systematic reviews/meta-analyses. Primarily preclinical evidence.

Improves (the measure goes up)Small effect11 studies

Studies that measured kidney function

and 1 more in the citations list

Cardiac Protection

4 human trials support this finding. Human clinical trial data available.

Improves (the measure goes up)Small effect8 studies

Studies that measured cardiac protection

Sepsis Outcomes

3 preclinical studies support this finding. Primarily preclinical evidence.

Improves (the measure goes down)Small effect7 studies

Studies that measured sepsis outcomes

Reproductive Outcomes

3 human trials support this finding. Human clinical trial data available.

Improves (the measure goes up)Small effect6 studies

Studies that measured reproductive outcomes

Sleep Quality

2 preclinical studies support this finding. Primarily preclinical evidence.

Improves (the measure goes up)Small effect6 studies

Key findings

  • Mortality (Less Severe Sepsis)Vasodilatory ShockImproves (the measure goes down)
  • Norepinephrine SparingVasodilatory ShockImproves (the measure goes down)
  • Blood Pressure SupportVasodilatory ShockImproves (the measure goes up)

Studies cited

46 studies from PubMed

  1. Hemodynamic effects of adjunct arginine vasopressin to norepinephrine in septic shock: insights from a prospective multicenter registry studyCrit Care, 2025 · PMID 40299108
  2. Characterization of a functional V(1B) vasopressin receptor in the male rat kidney: evidence for cross talk between V(1B) and V(2) receptor signaling pathways.American journal of physiology. Renal physiology, 2021 · PMID 34282956
  3. Diabetes insipidus.Presse medicale (Paris, France : 1983), 2021 · PMID 34718110
  4. Vasopressin and its analogues in shock states: a reviewAnn Intensive Care, 2020 · PMID 31970567
  5. Management of central diabetes insipidus.Best practice & research. Clinical endocrinology & metabolism, 2020 · PMID 32169331
  6. Gestational diabetes insipidus: Diagnosis and management.Best practice & research. Clinical endocrinology & metabolism, 2020 · PMID 32205050
  7. Diagnosis and differential diagnosis of diabetes insipidus: Update.Best practice & research. Clinical endocrinology & metabolism, 2020 · PMID 32387127
  8. Central Diabetes Insipidus Caused by Arginine Vasopressin Gene Mutation: Report of a Novel Mutation and Review of Literature.Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme, 2020 · PMID 32629514
  9. Genetic forms of neurohypophyseal diabetes insipidus.Best practice & research. Clinical endocrinology & metabolism, 2020 · PMID 32712149
  10. Perioperative urinary excretion of aquaporin-2 dependent upon vasopressin in cardiac surgery.Heart and vessels, 2020 · PMID 31701228
  11. [Nephrogenic syndrome of inappropriate antidiuresis].The Pan African medical journal, 2019 · PMID 31312322
  12. Diabetes insipidus.Nature reviews. Disease primers, 2019 · PMID 31395885
  13. Reduced levels of vasopressin, an independent mechanism in the obesity paradox in patients with chronic heart failure: Insights from the DAMOCLES study.International journal of cardiology, 2019 · PMID 30409739
  14. Arginine vasopressin antagonism in heart failure: Current status and possible new directions.Journal of cardiology, 2019 · PMID 30904236
  15. Sleep quality is associated with vasopressin methylation in pregnant and postpartum women with a history of psychosocial stress.Psychoneuroendocrinology, 2019 · PMID 31132568
  16. Vasopressin, Central Autonomic Control and Blood Pressure Regulation.Current hypertension reports, 2018 · PMID 29480411
  17. Hydration for Health Conference Emphasizes Vasopressin and Kidney Diseases.Annals of nutrition & metabolism, 2018 · PMID 29920502
  18. [The pathway of vasopressin as a pharmacological target in nephrology: a narrative review].Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia, 2018 · PMID 30550035
  19. Pancreatic Neuroendocrine Tumor Producing Insulin and Vasopressin.Endocrine pathology, 2018 · PMID 28718084
  20. Elevated vasopressin in pregnant mice induces T-helper subset alterations consistent with human preeclampsia.Clinical science (London, England : 1979), 2018 · PMID 29371289
  21. The Septic Shock 3.0 Definition and Trials: A Vasopressin and Septic Shock Trial ExperienceCrit Care Med, 2017 · PMID 28333757
  22. Central and peripheral roles of vasopressin in the circadian defense of body hydration.Best practice & research. Clinical endocrinology & metabolism, 2017 · PMID 29224666
  23. Cardiac effects of vasopressin.Journal of cardiovascular pharmacology, 2014 · PMID 24621650
  24. Vasopressin in septic shock: an individual patient data meta-analysis of randomised controlled trialsIntensive Care Med, 2012 · PMID 22797452
  25. Vasopressin versus norepinephrine infusion in patients with septic shockN Engl J Med, 2008 · PMID 18305265
  26. Vasopressin decreases sepsis-induced pulmonary inflammation through the V2R.Resuscitation, 2008 · PMID 18951114
  27. Vasopressin: mechanisms of action on the vasculature in health and in septic shock.Critical care medicine, 2007 · PMID 17133186
  28. Effects of arginine vasopressin during resuscitation from hemorrhagic hypotension after traumatic brain injuryCrit Care Med, 2006 · PMID 16424725
  29. [Nephrogenic diabetes insipidus].Nephrologie & therapeutique, 2006 · PMID 17081961
  30. [Regulation by vasopressin of NaCl absorption in the renal collecting duct].Journal de la Societe de biologie, 2005 · PMID 16738531
  31. Science Review: Vasopressin and the cardiovascular system part 2 - clinical physiology.Critical care (London, England), 2004 · PMID 14975041
  32. Arginine vasopressin in advanced vasodilatory shock: a prospective, randomized, controlled studyCirculation, 2003 · PMID 12732600
  33. Management of vasodilatory shock: defining the role of arginine vasopressinCrit Care Med, 2003 · PMID 12534330
  34. Vasopressin: a new target for the treatment of heart failureHeart Fail Rev, 2003 · PMID 12851603
  35. [Indications of vasopressin in the management of septic shock].Annales francaises d'anesthesie et de reanimation, 2003 · PMID 12946492
  36. Science review: Vasopressin and the cardiovascular system part 1--receptor physiology.Critical care (London, England), 2003 · PMID 14624682
  37. Low-dose vasopressin in the treatment of vasodilatory septic shockAnesthesiology, 2002 · PMID 11445675
  38. The role of vasopressin in the treatment of vasodilation in shock states.The Annals of pharmacotherapy, 2000 · PMID 10676834
  39. Vasopressin deficiency contributes to the vasodilation of septic shockCirculation, 1997 · PMID 10963052
  40. A clinical review of the adaptive role of vasopressin in migraine.Cephalalgia : an international journal of headache, 1997 · PMID 9251870
  41. [Vasopressin, somatostatin and digestive hemorrhages in portal hypertension: the end of the tunnel?].Gastroenterologie clinique et biologique, 1994 · PMID 7875444
  42. Vasodilation associated with V2-type vasopressin activity: findings and implications.Molecular and cellular endocrinology, 1989 · PMID 2529156
  43. Vasopressin in circulatory control and hypertension.Journal of hypertension, 1985 · PMID 2935570
  44. Central cardiovascular regulation and the role of vasopressin: a review.Clinical and experimental hypertension. Part A, Theory and practice, 1984 · PMID 6398147
  45. Contribution of vasopressin to hypertension.Hypertension (Dallas, Tex. : 1979), 1982 · PMID 7049934
  46. [Vasopressin isoreceptors in the liver and kidney: relationship between hormone binding and biological response].Journal de physiologie, 1981 · PMID 6268774