Vasopressin
V1/V2 receptor agonist
Also Vasostrict, Pitressin, Antidiuretic hormone, ADH, Arginine vasopressin, AVP
- Evidence
- AStrong human evidence
- FDA status
- FDA approvedas of 2026-10-26
- Route
- Intravenous
- Studies cited
- 1 human0 animal or cell
It is a hospital drip that raises blood pressure in people in shock. A trial of 778 patients showed it works as well as the usual drug, but it did not help patients live longer.
Sold for
Vasopressin is the second-line pressor in septic shock, used to spare high doses of adrenaline-type drugs.
Studies say
A 778-patient randomized trial showed vasopressin raises blood pressure as well as norepinephrine without improving survival, which supports A for its approved hemodynamic indication.
Why grade A. The VASST trial randomized 778 patients with septic shock to vasopressin or norepinephrine added to open-label vasopressors and found no difference in 28-day mortality. The drug reliably raises blood pressure and reduces catecholamine requirements, which is the approved use and is supported by randomized data, so A, with the understanding that no survival benefit has been shown. 12
FDA. Vasopressin injection is approved by the FDA as Vasostrict (2014) and generics to raise blood pressure in adults with vasodilatory shock who remain hypotensive despite fluids and catecholamines. It is given as a continuous intravenous infusion in intensive care. 2
Written from 2 cited sources. Fact-checked 2026-10-27: 12 claims checked, 0 corrected. Last refreshed 2026-10-27. Not physician reviewed.
What this means for you
- What people take it for
- Very low blood pressure in shock
- Can a US doctor prescribe it?
- Yes, FDA approved for low blood pressure in shock.
- Properly tested in people?
- Yes, in a large controlled trial of 778 patients.
Evidence checklist
- Randomised controlled trial VASST, blinded randomized trialyes
- Human study over 100 people VASST, 778 septic shock patientsyes
- More than one research group Main trial plus label datano
- Clinical outcomes, not surrogate markers No 28- or 90-day survival differenceno
- Human safety data beyond case reports Limb and organ ischemia rates comparedyes
Drawn from the cited studies below. A dash means the sources give no information.
What it is
Vasopressin, also called antidiuretic hormone, is a nine-amino-acid peptide made in the hypothalamus and released from the posterior pituitary. At normal levels its main job is water balance: it tells the kidneys to hold on to water. At the much higher levels reached by infusion, it constricts blood vessels. The drug is a synthetic copy of the human hormone (8-arginine vasopressin). 2
Vasopressin had been used in US hospitals for decades as an unapproved marketed drug. Par Pharmaceutical obtained formal FDA approval in 2014 as Vasostrict under an initiative to bring old unapproved drugs through review, and generics have since been approved. 2
How it works
Vasopressin acts on V1 receptors on vascular smooth muscle, causing constriction, and on V2 receptors in the kidney's collecting ducts, causing water reabsorption. In septic shock the body's own vasopressin stores run low within a day or two, and the blood vessels become unresponsive to catecholamines like norepinephrine. Infused vasopressin restores vascular tone by a separate receptor pathway, which is why it can raise pressure when norepinephrine doses are already high, and it tends to spare the kidney's filtering vessels. 12
What human research shows
VASST, published in the New England Journal of Medicine in 2008, randomized 778 patients with septic shock already on norepinephrine at Canadian, Australian and US intensive care units to blinded low-dose vasopressin or additional norepinephrine. Mortality at 28 days was 35.4 percent with vasopressin and 39.3 percent with norepinephrine, a difference that was not statistically significant, and 90-day mortality was likewise similar. 1
In the prespecified subgroup with less severe shock (lower norepinephrine requirements at entry), 28-day mortality was 26.5 percent with vasopressin and 35.7 percent with norepinephrine, a difference the authors flagged as hypothesis-generating. Rates of serious adverse events did not differ between arms. 1
| Study | Model | Finding |
|---|---|---|
| VASST (Russell 2008) | Humans, n=778 with septic shock on norepinephrine, randomized double-blind, vasopressin versus norepinephrine | 28-day mortality 35.4 percent versus 39.3 percent, not significant; possible benefit in less severe shock; similar adverse event rates. 1 |
| Vasostrict prescribing information | FDA label | Approved indication in vasodilatory shock, ischemia and hyponatremia warnings. 2 |
Safety
Because it constricts blood vessels everywhere, vasopressin can cause ischemia of the fingers and toes, gut, skin and heart, particularly at higher infusion rates; in VASST, digital ischemia and other serious adverse events occurred at similar rates in both arms. Low sodium from water retention, and a fall in cardiac output or heart rate, are also listed effects. 12
The label notes that the drug has been studied only as an add-on in patients already receiving catecholamines, and that stopping it abruptly can cause blood pressure to fall. Use outside monitored settings is not described. 2
Questions for your clinician
- Does vasopressin change survival, or mainly reduce other drug needs?
- How are fingers, toes and gut ischemia watched for?
- Why is it given with other vasopressors, not on its own?
Questions people ask
Is vasopressin FDA-approved?
Yes. Vasostrict was approved in 2014 to raise blood pressure in adults with vasodilatory shock who remain hypotensive after fluids and catecholamines. The hormone had been used in hospitals for decades before that without formal approval. 2
Does vasopressin improve survival in septic shock?
The 778-patient VASST trial found no significant difference in 28-day mortality between vasopressin and norepinephrine (35.4 percent versus 39.3 percent). A subgroup with less severe shock did better on vasopressin, but that finding has not been confirmed as a primary result. 1
Why add vasopressin instead of more norepinephrine?
Vasopressin works through a different receptor, so it raises pressure when vessels have stopped responding well to catecholamines, and septic patients are often deficient in it. Adding it lets clinicians lower norepinephrine doses, which carry their own risks. 12
How does vasopressin differ from desmopressin and terlipressin?
Desmopressin is a modified vasopressin that acts mainly on the kidney's V2 receptors for water retention and bleeding disorders, with little blood-pressure effect. Terlipressin is a slow-release prodrug of vasopressin's vascular (V1) activity used for hepatorenal syndrome. 2