Table of ContentsView AllTable of ContentsFunction in the BodyAbnormalitiesUse in MedicineHow It Is GivenSide Effects
Table of ContentsView All
View All
Table of Contents
Function in the Body
Abnormalities
Use in Medicine
How It Is Given
Side Effects
In medicine, a synthetic version called Vasostrict is given in emergencies to raise blood pressure in people who have gone intoshock.In addition to its approved use, Vasostrict is sometimes taken off-label to treat gastrointestinal bleeding, bleeding disorders, and other medical conditions.
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Vasopressin Hormone Functions and Effects
Regulation of Body Fluids
Vasopressin is responsible for maintaining the normal balance of fluids around cells, referred to as tonicity. If fluid levels become low, the blood will become more concentrated. In response, the pituitary gland secretes vasopressin, causing thekidneysto reabsorb water and return it to circulation.
By increasing permeability, vasopressin can return the tonicity of body fluids to normal.
Regulation of Blood Pressure
Vasopressin is also a potent vasoconstrictor that acts onsmooth musclessurrounding blood vessels, causing them to narrow (constrict).
The modulating effect of vasopressin can help keep blood pressure from fluctuating excessively.
Effects on the Brain
Vasopressin is also a centralneurotransmitter, meaning a chemical messenger that acts on thecentral nervous system(comprised of the brain and spinal cord). Its action on the brain is centered around a part of the hypothalamus, called the suprachiasmatic nucleus, that regulatescircadian rhythmsin the body.
Circadian rhythms are part of the body’s internal clock, running in the background so that biological processes occur at the correct time, day or night, to keep the body functioning. Chief among these is the body’ssleep-wake cycle.
Without circadian rhythms, the body’s ability to maintain homeostasis—including functions like sleep, appetite, digestion, body temperature, and hormone release—would be severely compromised.
Effect on Mood and Behaviors
Vasopressin also acts on parts of the brain called theprefrontal cortex(the brain’s “personality center”) andamygdala(which processes emotion), where it is thought to influence social and emotional states, including fear, anxiety, and aggression. This seems especially true in males.
Other Effects
Vasopressin is also associated withnauseaand may serve to trigger the vomiting reflex (emesis) when there is a gastrointestinal illness or poisoning.
Vasopressin is also known to act on thepancreasand increase the production ofinsulin, the hormone that helps regulate blood sugar. Persistently high levels of vasopressin are associated with an increased risk of diabetes.
Normal vs. Abnormal Vasopressin Release
The underproduction or overproduction of vasopressin can have serious health consequences. Chief among these is the disruption ofsodiumlevels in the blood. Abnormally high or low sodium levels cause fluid retention and also disrupt vital functions like heart rhythms and muscle contractions.
Low Vasopressin
Large amounts of diluted urine and excessive thirst (polydipsia) are characteristic of a group of conditions formerly known asdiabetes insipidus. This included “central diabetes insipidus” associated with vasopressin production and “nephrogenic diabetes insipidus” associated with vasopressin response.
Today, these conditions are respectively described as:
Both AVD and AVR cause excessive urination, which can lead to abnormally high blood sodium levels, known ashypernatremia. Symptoms of hyponatremia include nausea, vomiting, thirst, restlessness, muscle twitches, spasms, confusion, and, in severe cases,intracranial bleeding.
High Vasopressin
Overstimulation of the hypothalamus can lead to a condition calledsyndrome of inappropriate antidiuretic hormone secretion (SIADH), in which excessive amounts of vasopressin are produced, leading to decreased urination.
Many different things can cause SIADH, some of which include:
The overproduction of vasopressin dilutes sodium levels as excessive amounts of water are retained, leading tohyponatremia.Symptoms of hyponatremia include nausea, vomiting, headaches, loss of appetite, balance problems, mental changes, and, in severe cases, seizures and coma.
Persistently high vasopressin levels can also increase insulin production. Over time, this can reduce the body’s sensitivity to insulin, resulting inglucose intoleranceandtype 2 diabetes.
Complications
Certain progressive kidney and heart diseases can lead to organ damage or failure due to SIADH and the overproduction of vasopressin. These include:
When to Consider Vasopressin Injections
A synthetic version of the hormone can replicate the effects of natural vasopressin and be prescribed for different medical purposes.
The synthetic version has been taken for more than 100 years and was initially released under the brand name Pitressin.The U.S. Food and Drug Administration (FDA) has licensed it under the brand name Vasostrict.
As with othertypes of shock, vasodilatory shock causes a reduction of circulating blood, which deprives organs of the oxygen they need to survive. If not treated aggressively, vasodilatory shock can lead to multi-organ failure and death.
Several types of shock fall under the umbrella of vasodilatory shock, including:
Off-Label Uses
Examples include:
Surgeons will sometimes use Vasostrict to reduce the risk of bleeding during and after surgery.This is especially true for people with bleeding disorders who lackplateletsorclotting factorsto stem bleeding.
DDVAP is currently licensed to treat central diabetes insipidus, hemophilia, and von Willebrand disease.
Similarly,gastroenterologistsorhepatologists(liver specialists) sometimes use Vasostrict to treat esophageal varices but tend to prefer a drug called Sandostatin (octreotide), which has fewer serious side effects.
How to Administer Vasopressin Injections
Vasostrict is typically givenintravenously(into a vein) but is also sometimes deliveredsubcutaneously(under the skin) for the management of AVD.
Side Effects to Monitor
As with all medications, Vasostrict can cause side effects, some of which may be severe. Given that the drug is frequently used in emergencies, the benefits tend to outweigh the risks. If used for the management of AVD, speak with a specialist to make an informed choice.
Side effects commonly seen with intravenous Vasostrict include:
In addition, people may experience temporary AVD, leading to hypernatremia. Tapering the dose after the blood pressure is normalized may help reduce the risk.
The only absolute contraindication to Vasostrict is a known severe allergy to synthetic vasopressin or chlorobutanol (a preservative used in the Vasostrict formulation).
Though Vasostrict’s effect on a fetus during pregnancy is unknown, studies suggest that it may induce uterine contractions, potentially leading tomiscarriageorpreterm birth. Its safety in children, nursing babies, and older adults has also not been established.
Summary
Vasopressin is a hormone that the hypothalamus produces and the pituitary gland secretes. It slows down urine output and causes blood vessels to constrict. By doing so, it can maintain the normal balance of fluids in the body, regulate blood pressure, and maintain circadian rhythm and overall homeostasis. It also influences behaviors and emotions like fear, vigilance, and love.
Vasopressin is also manufactured as an injectable drug called Vasostrict, which can treat vasodilatory shock. It can also be prescribed off-label to manage vasopressin deficiency, prevent postoperative or intraoperative bleeding, and treat bleeding disorders, esophageal variceal bleeding, or cardiac arrest.
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