Peptide reference
Vasopressin
Arginine vasopressin ·AVP ·Antidiuretic hormone ·ADH ·Vasostrict ·Pitressin
What cited sources report about Vasopressin
Vasopressin (arginine vasopressin, AVP) is the endogenous nonapeptide neurohypophyseal hormone that mediates antidiuretic and vasoconstrictor responses through V1a, V1b, and V2 receptors. The synthetic preparation is FDA-approved as Vasostrict (Endo USA) for vasodilatory shock; older preparations (Pitressin) were also used historically for diabetes insipidus and abdominal distension. The summaries below report what individual cited sources state; this page does not assert claims beyond what those sources report.
FDA DailyMed — Vasostrict prescribing information
The current US prescribing information for Vasostrict lists a single FDA-approved indication: increase of blood pressure in adults with vasodilatory shock (e.g., post-cardiotomy or septic) who remain hypotensive despite fluids and catecholamines. The recommended starting infusion is 0.01-0.04 units/min (some references support up to 0.07 units/min), titrated to mean arterial pressure target.
VASOSTRICT is indicated to increase blood pressure in adults with vasodilatory shock (e.g., post-cardiotomy or sepsis) who remain hypotensive despite fluids and catecholamines.
Russell et al. (2008) — New England Journal of Medicine (VASST)
The Vasopressin and Septic Shock Trial (VASST) was a multicenter randomized double-blind trial in 778 patients with septic shock receiving open-label norepinephrine, randomized to add low-dose vasopressin (0.01-0.03 U/min) or additional norepinephrine. The authors reported no significant difference in 28-day mortality (35.4% vs 39.3%) but observed a possible benefit in the prespecified less-severe shock subgroup.
Low-dose vasopressin did not reduce mortality rates as compared with norepinephrine among patients with septic shock who were treated with catecholamines.
Gordon et al. (2016) — JAMA (VANISH)
The VANISH trial was a 2x2 factorial randomized double-blind trial in 409 patients with septic shock that surveyed early vasopressin versus norepinephrine, each with or without hydrocortisone. The primary endpoint of kidney-failure-free days did not differ significantly between vasopressin and norepinephrine, although vasopressin reduced renal-replacement-therapy use (25.4% vs 35.3%).
Among adults with septic shock, the early use of vasopressin compared with norepinephrine did not improve the number of kidney failure-free days.
Mamede et al. (2026) — American Journal of Emergency Medicine
A 2026 systematic review and meta-analysis corrigendum surveyed pooled randomized and observational data on early vasopressin plus norepinephrine versus delayed or no vasopressin in septic shock and summarized mortality, renal, and hemodynamic outcomes.
Merck Manuals — Sepsis and Septic Shock
The Merck Manual Professional Version chapter on sepsis describes vasopressor selection: norepinephrine as first-line, with vasopressin (up to 0.03 units/min) added as a second-line agent to reduce catecholamine requirements or substituted when norepinephrine alone is inadequate. The chapter aligns with Surviving Sepsis Campaign guidance.
PubChem CID 644077 — National Center for Biotechnology Information
PubChem record for arginine vasopressin listing the endogenous nonapeptide Cys-Tyr-Phe-Gln-Asn-Cys-Pro-Arg-Gly-NH2 with a 1-6 disulfide bridge, molecular formula C46H65N15O12S2, molecular weight 1084.2 g/mol, and aggregated synonyms (AVP, antidiuretic hormone, ADH, Pitressin).
Coverage notes
Vasopressin is one of the oldest known peptide hormones (sequence determined by du Vigneaud, Nobel Prize 1955) and one of the most widely used catecholamine-sparing vasopressors in modern critical care. The VASST and VANISH trials are the two principal randomized clinical trials informing its place in septic-shock management. This page reflects FDA labeling and randomized trial evidence current as of the cited sources.