Vasostrict, ADH
Evidence Grade A — Regulatory approved. 37698 published studies. 330 registered clinical trials.
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Vasopressin (sold as Vasostrict) is a synthetic version of the body's natural antidiuretic hormone, used in intensive care to raise dangerously low blood pressure during septic shock and other forms of circulatory collapse. It works through a completely different mechanism than the standard blood-pressure drugs used in ICUs, making it useful when conventional treatments alone are not enough.
37,698 published studies: 14951 human, 19937 animal, 2809 in-vitro, 4862 reviews
Vasopressin is marketed as Vasostrict (approved 2014) for vasodilatory shock. It was previously included in advanced cardiac life support protocols for cardiac arrest but was removed from guidelines in 2020 after failing to show superiority over adrenaline.
Vasopressin gained public attention for dramatic price increases — the cost rose from approximately $4 per vial to over $300 following regulatory changes requiring approved formulations in critical care. This became a prominent case study in pharmaceutical pricing debates. Clinically, vasopressin remains a standard second-line vasopressor in septic shock alongside noradrenaline, and its non-catecholamine mechanism provides a complementary approach to blood pressure support.
Vasopressin works through three different receptor types. In blood vessels, it causes powerful constriction, raising blood pressure — which is its primary use in shock. In the kidneys, it tells the collecting ducts to reabsorb water rather than excrete it, concentrating the urine and maintaining blood volume. A third receptor type in the pituitary gland mediates the release of ACTH (a stress hormone). In critical care, its blood pressure-raising effect operates through a different pathway than standard vasopressors like noradrenaline, making it useful when conventional treatments alone are insufficient.
Vasopressin is a standard second-line blood pressure support in septic shock, used alongside noradrenaline. Clinical trials (VANISH, VASST) provided mixed evidence for a direct mortality benefit but supported its role as a catecholamine-sparing agent — meaning it helps maintain blood pressure while reducing the dose of other drugs that can stress the heart. Vasopressin was previously part of cardiac arrest protocols but was removed in 2020 after failing to show superiority over adrenaline. The drug gained public attention for dramatic price increases — from approximately $4 to over $300 per vial — which became a prominent case study in pharmaceutical pricing debates. Research into more selective vasopressin-like drugs (targeting only the blood vessel receptors without the kidney and hormonal effects) continues.
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Health Canada Market Authorisation
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