Does Vasopressin work?
Yes, in a large controlled trial of 778 patients.
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
VASST appeared in the New England Journal of Medicine in 2008. It randomized 778 patients with septic shock who were already on norepinephrine. They were in intensive care units in Canada, Australia and the US. Patients got blinded low-dose vasopressin or more norepinephrine. Death within 28 days was 35.4 percent with vasopressin and 39.3 percent with norepinephrine. That gap was not statistically significant. Death within 90 days was also similar. 1
One subgroup was set out before the trial. It had less severe shock, meaning lower norepinephrine needs at entry. In this subgroup, 28-day mortality was 26.5 percent with vasopressin and 35.7 percent with norepinephrine. The authors flagged this gap as a lead for future study, not proof. Serious side effects did not differ between arms. 1
Evidence checklist
- Randomised controlled trial VASST, blinded randomized trial
- Human study over 100 people VASST, 778 septic shock patients
- More than one research group Main trial plus label data
- Clinical outcomes, not surrogate markers No 28- or 90-day survival difference
- Human safety data beyond case reports Limb and organ ischemia rates compared
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Reference information only, not medical advice. Drawn from the Vasopressin article, fact-checked against the cited sources. No dosing anywhere on this site.