{"id":"vasopressin","name":"Vasopressin","aliases":["Vasostrict","argipressin","antidiuretic hormone","ADH"],"url":"https://lyoresearch.com/compounds/vasopressin","class":{"id":"endocrine-medicines","name":"Established peptide medicines","url":"https://lyoresearch.com/classes/endocrine-medicines"},"summary":"Vasopressin is the nine-amino-acid pituitary hormone that constricts blood vessels and concentrates urine, used in intensive care as a second vasopressor in septic shock. In VASST, the 778-patient randomised trial that defined its role, adding vasopressin to noradrenaline did not reduce 28-day or 90-day mortality. It is approved in the US as Vasostrict for raising blood pressure in adults with vasodilatory shock, given by intravenous infusion, and is hospital-use only.","overall_grade":"A","overall_grade_meaning":"established in humans","human_trials":"VASST (n=778) and the ICU literature","regulatory_status":"Approved (Rx)","molecule":{"formula":"C46H65N15O12S2","molecular_weight":"1084.2","cas":"113-79-1","pubchem_cid":644077,"sequence":"CYFQNCPRG-NH2","sequence_note":"One disulfide bridge, Cys1-Cys6.","note":"Recorded as argipressin, the human (arginine) form"},"pharmacokinetics":{"basis":"label","route":"Intravenous infusion (hospital use)","half_life":"Apparent half-life no more than 10 minutes","licensed_regimen":"A continuous infusion started at a low rate and titrated to the target blood pressure, in monitored care","product":"Vasostrict","source":{"title":"Vasostrict prescribing information (DailyMed)","url":"https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b1147beb-743e-4c62-8927-91192447f8b8"}},"outcomes":[{"outcome":"Mortality in septic shock","grade":"A","grade_meaning":"established in humans","effect_size":"not measurable","adverse":false,"human_studies":"1 large RCT (VASST, n=778)","evidence":"VASST randomised 778 patients with septic shock to vasopressin or noradrenaline infusion in addition to open-label vasopressors. There was no difference in 28-day or 90-day mortality. A large, well-conducted negative trial, and the reason vasopressin is a catecholamine-sparing adjunct rather than a survival intervention.","references":[{"citation":"Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock (VASST).","where":"N Engl J Med, 2008;358:877–887","url":"https://pubmed.ncbi.nlm.nih.gov/18305265/"}],"verbatim":{"text":"There was no significant difference between the vasopressin and norepinephrine groups in the 28-day mortality rate (35.4% and 39.3%, respectively; P=0.26) or in 90-day mortality (43.9% and 49.6%, respectively; P=0.11).","citation":"Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock (VASST).","url":"https://pubmed.ncbi.nlm.nih.gov/18305265/"}},{"outcome":"Raising blood pressure in vasodilatory shock","grade":"A","grade_meaning":"established in humans","effect_size":"moderate","adverse":false,"human_studies":"Approval programme; label","evidence":"The licensed indication. Vasopressin raises mean arterial pressure through V1 receptors on vascular smooth muscle by a pathway independent of the adrenergic receptors, which is why it works when catecholamines are failing and why it lets their dose come down.","references":[{"citation":"Vasostrict (vasopressin injection) prescribing information.","where":"DailyMed, read 29 Oct 2026","url":"https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b1147beb-743e-4c62-8927-91192447f8b8"}]},{"outcome":"Serious adverse events","grade":"A","grade_meaning":"established in humans","effect_size":"not measurable","adverse":true,"human_studies":"1 large RCT (VASST, n=778)","evidence":"In VASST serious adverse events occurred at the same rate in both arms. The clinically watched risks — digital and mesenteric ischaemia from intense vasoconstriction — did not separate the groups at the doses studied.","references":[{"citation":"Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock (VASST).","where":"N Engl J Med, 2008;358:877–887","url":"https://pubmed.ncbi.nlm.nih.gov/18305265/"}],"verbatim":{"text":"There were no significant differences in the overall rates of serious adverse events (10.3% and 10.5%, respectively; P=1.00).","citation":"Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock (VASST).","url":"https://pubmed.ncbi.nlm.nih.gov/18305265/"}},{"outcome":"Water retention and low sodium","grade":"A","grade_meaning":"established in humans","effect_size":"moderate","adverse":true,"human_studies":"Label; the desmopressin literature","evidence":"V2 receptor activation in the kidney is the antidiuretic effect, and its consequence is dilutional hyponatraemia — the harm that defines the whole vasopressin family, and the reason its analogue desmopressin carries a sodium warning in older patients.","references":[{"citation":"Vasostrict (vasopressin injection) prescribing information.","where":"DailyMed, read 29 Oct 2026","url":"https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b1147beb-743e-4c62-8927-91192447f8b8"}]}],"regions":[{"region":"European Union","status":"Authorised nationally, hospital use","note":"Argipressin products authorised in several member states for vasodilatory shock and diagnostic use."},{"region":"United States","status":"Approved, prescription-only","note":"Vasostrict approved to increase blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines. Intravenous infusion, hospital use."},{"region":"United Kingdom","status":"Licensed, hospital use","note":"Argipressin licensed for vasodilatory shock."},{"region":"Australia","status":"Registered, Schedule 4","note":"Registered for hospital use."},{"region":"Canada","status":"Authorised, prescription-only","note":"Vasopressin injection authorised with a Drug Identification Number."},{"region":"Sport (WADA)","status":"Not prohibited as such","note":"Vasopressin itself is not named; its analogue desmopressin is prohibited as a masking agent (S5), and plasma expanders and masking agents are the relevant category."}],"faq":[{"q":"Does vasopressin save lives in septic shock?","a":"Its largest randomised trial, in 778 patients, found no difference in 28-day or 90-day mortality against noradrenaline. It is used to raise blood pressure and reduce the catecholamine dose, which is a different claim from improving survival."},{"q":"Is vasopressin the same as desmopressin?","a":"No. Desmopressin is a modified version that keeps the kidney (V2) effect and largely loses the blood-vessel (V1) effect, which is why it treats diabetes insipidus and bedwetting while vasopressin is a vasopressor."},{"q":"Why is it only used in hospital?","a":"Its half-life is minutes, it is given by continuous intravenous infusion, and the dose is titrated against arterial pressure. There is no formulation or circumstance in which it is used outside monitored care."}],"references":[{"cite":"Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock (VASST).","where":"N Engl J Med, 2008;358:877–887","url":"https://pubmed.ncbi.nlm.nih.gov/18305265/","note":"778 randomised; no difference in 28-day or 90-day mortality."},{"cite":"Vasostrict (vasopressin injection) prescribing information.","where":"DailyMed, read 29 Oct 2026","url":"https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b1147beb-743e-4c62-8927-91192447f8b8","note":"Intravenous infusion; apparent half-life under 10 minutes; indication in vasodilatory shock; chemical structure."},{"cite":"PubChem compound record: argipressin (vasopressin).","where":"PubChem, read 29 Oct 2026","url":"https://pubchem.ncbi.nlm.nih.gov/compound/644077","note":"Formula, molecular weight, CAS and the nine-residue sequence used on this page."}],"last_reviewed":"2026-10-29","literature_searched_to":"2026-10-29","changelog":[{"date":"2026-10-29","note":"Initial publication. Grade A throughout, including the negative mortality row from VASST."}],"license":"CC BY 4.0 — cite as “LYO Research” with a link.","methodology":"https://lyoresearch.com/methodology"}