Vasopressin and its Analogs

  • G. Auzinger
  • J. Wendon


Hypotension due to peripheral vasodilation and reduced responsiveness to vasopressor therapy are cardinal features of septic, and other forms of vasodilatory, shock. The nonosmotic release of the peptide hormone arginine-vasopressin in response to hypotension and hypovolemia, is an important defense mechanism to counteract systemic hypotension and maintain adequate tissue perfusion. Despite an initial appropriate response, vasopressin plasma levels fall and are inappropriately low in later stages of septic shock [1].


Septic Shock Mean Arterial Pressure KATP Channel Septic Shock Patient Vasopressin Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Landry DW, Levin HR, Gallant EM, et al (1997) Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation 95: 1122–1125PubMedCrossRefGoogle Scholar
  2. 2.
    Malay MB, Ashton RC, Landry DW, Townsend RN (1999) Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 47: 699–703PubMedCrossRefGoogle Scholar
  3. 3.
    Argenziano M, Choudhri AF, Oz MC, Rose EA, Smith CR, Landry DW (1997) A prospective randomized trial of arginine vasopressin in the treatment of vasodilatory shock after left ventricular assist device placement. Circulation 96:I1 286–290Google Scholar
  4. 4.
    Moncada S, Higgs A (1993) The L-arginine-nitric oxide pathway. N Engl J Med 329: 20022012Google Scholar
  5. 5.
    Cobb JP, Danner RJ (1996) Nitric oxide and septic shock. JAMA 275: 1192–1196PubMedCrossRefGoogle Scholar
  6. 6.
    Grover R, Zaccardelli D, Colice G, Guntupalli K, Watson D, Vincent JL (1999) An open label dose escalation study of the nitric oxide synthase inhibitor, N(G)-methyl-arginine hydrochloride (546C88), in patients with septic shock. Crit Care Med 27: 913–922PubMedCrossRefGoogle Scholar
  7. 7.
    Kirov MY, Evgenov OV, Evgenov NV, et al (2001) Infusion of methylene blue in human septic shock: A pilot, randomized, controlled study. Crit Care Med 29: 1860–1867Google Scholar
  8. 8.
    Grover R, Lopez A, Lorente J, et al (1999) Multicenter, randomized, placebo-controlled, double blind study of the nitric oxide synthase inhibitor 546C88: Effect on survival in patients in septic shock. Crit Care Med 27: A33 (Abst)Google Scholar
  9. 9.
    Landry DW, Oliver JA (1992) The ATP-sensitive K+ channel mediates hypotension in endotoxemia and hypoxic lactic acidosis in dog. J Clin Invest 89: 2071–2074PubMedCrossRefGoogle Scholar
  10. 10.
    Davies NW (1990) Modulation of ATP-sensitive K+ channels in skeletal muscle by intracellular protons. Nature 343: 375–377PubMedCrossRefGoogle Scholar
  11. 11.
    Keung EC, Li Q (1991) Lactate activates ATP-sensitive potassium channels in guinea pig ventricular myocytes. J Clin Invest 88: 1772–1777PubMedCrossRefGoogle Scholar
  12. 12.
    Morales D, Madigan J, Cullinane, et al (1999) Reversal by vasopressin of intractable hypotension in the late phase of hemorrhagic shock. Circulation 100: 226–229PubMedCrossRefGoogle Scholar
  13. 13.
    Morales DL, Gregg D, Heiman DN, et al (2000) Arginine vasopressin in the treatment of 50 patients with postcardiotomy vasodilatory shock. Ann Thorac Surg 69: 102–106PubMedCrossRefGoogle Scholar
  14. 14.
    Cooke CR, Wall BM, Jones GV, Presley DN, Share L (1993) Reversible vasopressin deficiency in severe hypernatremia. Am J Kidney Dis 22: 44–52PubMedGoogle Scholar
  15. 15.
    Reid IA (1994) Role of nitric oxide in the regulation of renin and vasopressin secretion. Front Neuroendocrinol 15: 351–383PubMedCrossRefGoogle Scholar
  16. 16.
    Mohring J, Glanzer K, Maciel JA Jr, et al (1980) Greatly enhanced pressor response to antidiuretic hormone in patients with impaired cardiovascular reflexes due to idiopathic orthostatic hypotension. J Cardiovasc Pharmacol 2: 367–376PubMedCrossRefGoogle Scholar
  17. 17.
    Wagner HN Jr, Braunwald E (1956) The pressor effect of the antidiuretic principle of the posterior pituitary in orthostatic hypotension. J Clin Invest 35: 1412–1418PubMedCrossRefGoogle Scholar
  18. 18.
    Bartelstone HJ, Nasmyth PA (1965) Vasopressin potentiation of catecholamine actions in dog, rat, cat and rat aortic strip. Am J Physiol 208: 754–762PubMedGoogle Scholar
  19. 19.
    Wakatsuki T, Nakaya Y, Inoue I (1992) Vasopressin modulates K+-channel activities of cultured smooth muscle cells from porcine coronary artery. Am J Physiol 263: H491 - H496PubMedGoogle Scholar
  20. 20.
    Umino T, Kusano E, Muto S, et al (1999) AVP inhibits LPS- and IL- l/i-stimulated NO and cGMP via VI receptor in cultured rat mesangial cells. Am J Physiol 276: F433 - F441PubMedGoogle Scholar
  21. 21.
    Cowley AW Jr, Monos E, Guyton AC (1974) Interaction of vasopressin and the baroreceptor reflex system in the regulation of arterial blood pressure in the dog. Circ Res 34: 505–514PubMedCrossRefGoogle Scholar
  22. 22.
    Garrard CS, Kontoyannis DA, Piepoli M (1993) Spectral analysis of heart rate variability in the sepsis syndrome. Clin Auton Res 3: 5–13PubMedCrossRefGoogle Scholar
  23. 23.
    Chen JM, Cullinane S, Spanier TB, et al (1999) Vasopressin deficiency and pressor hypersensitivity in hemodynamically unstable organ donors. Circulation 100:II 244–246Google Scholar
  24. 24.
    Tsuneyoshi I, Yamada H, Kakihana Y, Nakamura M, Nakano Y, Boyle WA (2001) Hemodynamic and metabolic effects of low-dose vasopressin infusion in vasodilatory septic shock. Crit Care Med 29: 487–493PubMedCrossRefGoogle Scholar
  25. 25.
    Landry DW, Levin Hr, Gallant EM, et al (1997) Vasopressin pressor hypersensitivity in vasodilatory septic shock. Crit Care Med 25: 1279–1282PubMedCrossRefGoogle Scholar
  26. 240.
    G. Auzinger and J. Wendon: Vasopressin and its AnalogsGoogle Scholar
  27. 26.
    Rosenzweig EB, Starc TJ, Chen JM, et al (1999) Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 100:Ií 182–186Google Scholar
  28. 27.
    Gold JA, Cullinane S, Chen J, Oz MC, Oliver JA, Landry DW (2000) Vasopressin as an alternative to norepinephrine in the treatment of milrinone-induced hypotension. Crit Care Med 28: 249–252PubMedCrossRefGoogle Scholar
  29. 28.
    Argenziano M, Chen JM, Cullinane S, et al (1999) Arginine vasopressin in the management of vasodilatory hypotension after cardiac transplantation. J Heart Lung Transplant 18: 814817Google Scholar
  30. 29.
    Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA (2001) The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 27: 1416–1421PubMedCrossRefGoogle Scholar
  31. 30.
    Duenser MW, Mayr AJ, Ulmer H, et al (2001) The effects of vasopressin on systemic hemodynamics in catecholamine-resistant septic and postcardiotomy shock: a retrospective analysis. Anesth Analg 93: 7–13CrossRefGoogle Scholar
  32. 31.
    Lamarre P, Perreault B, Lesur 0 (2001) Vasopressin and blood pressure support for pancreatitis-induced systemic inflammatory response syndrome with circulatory shock. Pharmacotherapy 21: 506–508Google Scholar
  33. 32.
    Varga C, Pavo I, Lamarque D, et al (1998) Endogenous vasopressin increases acute endotoxin provoked gastrointestinal mucosal injury in the rat. Eur J Pharmacol 352: 257–261PubMedCrossRefGoogle Scholar
  34. 33.
    Erwald R, Wiechel KL, Strandell T (1976) Effect of vasopressin on regional splanchnic blood flows in conscious man. Acta Chir Scand 142: 36–42PubMedGoogle Scholar
  35. 34.
    Lambert M, de Peyer R, Muller AF (1982) Reversible ischemic colitis after intravenous vasopressin therapy. JAMA 247: 666–667PubMedCrossRefGoogle Scholar
  36. 35.
    Willems MG, Schoenemann J, Rey C, Schafer H, Lindecken KD (1985) Ischemia of the cecum caused by glycylpressin. Leber Magen Darm 15: 165–168PubMedGoogle Scholar
  37. 36.
    Schmitt W, Wagner-Thiessen E, Lux G (1987) Ischemic colitis in a patient treated with glypressin for bleeding oesophageal varices. Hepatogastroenterology 34: 134–136PubMedGoogle Scholar
  38. 37.
    Escorsell A, Del Arbol LR, Planas R, et al (2000) Multicenter randomized controlled trial of terlipressin versus sclerotherapy in the treatment of acute variceal bleeding: The TEST study. Hepatology 32: 471–476Google Scholar
  39. 38.
    Uriz J, Gines P, Cardenas A, et al (2000) Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome. J Hepatol 33: 43–48PubMedCrossRefGoogle Scholar
  40. 39.
    D’Amico G, Traina M, Vizzini G, et al (1994) Terlipressin or vasopressin plus transdermal nitroglycerin in a treatment strategy for digestive bleeding in cirrhosis. A randomized clinical trial. J Hepatol 20: 206–212Google Scholar
  41. 40.
    Barriere E, Tazi KA, Poirel O, Lebrec D, Moreau R (2001) Terlipressin administration decreases iNOS expression and improves circulatory and liver dysfunction in endotoxin-challenged rats with cirrhosis. J Heptol 34 (Suppl 1 ): A519 (Abst)Google Scholar
  42. 41.
    Scharte M, Meyer J, Van Aken H, Bone HG (2001) Hemodynamic effects of terlipressin (a synthetic analog of vasopressin) in healthy and endotoxemic sheep. Crit Care Med 29: 1756–1760PubMedCrossRefGoogle Scholar
  43. 42.
    O’Brian AJ, Clapp LH, Singer M (2001) The use of glypressin in norepinephrine-resistant septic shock. Intensive Care Med 27 (Suppl 2 ): A110 (Abst)Google Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • G. Auzinger
  • J. Wendon

There are no affiliations available

Personalised recommendations