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The Surviving Sepsis Campaign guidelines recommend the very early management of the sepsis focusing on the hour-1 bundle. This includes use of Vasopressin 0.03 units/minute as add-on to norepinephrine (NE) with intent of either raising the mean arterial pressure or decreasing the norepinephrine dosage (i.e. de-catecholaminization). [13]
An antihypotensive, also known as vasopressor, is an agent that raises blood pressure by constricting blood vessels, thereby increasing systemic vascular resistance. This is different from inotropes which increase the force of cardiac contraction. Some substances do both (e.g. dopamine, dobutamine).
The "vaptan" drugs act by directly blocking the action of vasopressin at its receptors (V 1A, V 1B and V 2).These receptors have a variety of functions, with the V 1A and V 2 receptors are expressed peripherally and involved in the modulation of blood pressure and kidney function respectively, while the V 1A and V 1B receptors are expressed in the central nervous system.
551 11998 Ensembl ENSG00000101200 ENSMUSG00000037727 UniProt P01185 P35455 RefSeq (mRNA) NM_000490 NM_009732 RefSeq (protein) NP_000481 NP_033862 Location (UCSC) Chr 20: 3.08 – 3.08 Mb Chr 2: 130.42 – 130.42 Mb PubMed search Wikidata View/Edit Human View/Edit Mouse Human vasopressin, also called antidiuretic hormone (ADH), arginine vasopressin (AVP) or argipressin, is a hormone synthesized ...
Terlipressin is indicated to improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function. [2]Indications for use include norepinephrine-resistant septic shock [7] although, 2021 Surviving Sepsis Guidelines recommend against its use for adults with septic shock [8] and hepatorenal syndrome. [9]
Among the choices for vasopressors, norepinephrine is superior to dopamine in septic shock. [17] Norepinephrine is the preferred vasopressor, while epinephrine may be added to norepinephrine when needed. Low-dose vasopressin also may be used as an addition to norepinephrine, but is not recommended as a first-line treatment.
Midodrine, sold under the brand names ProAmatine and Orvaten among others, is a vasopressor or antihypotensive medication used to treat orthostatic hypotension (low blood pressure when standing) and urinary incontinence. [3] [5] [1] It is taken by mouth. [3] [1]
The dominant mechanism of action for the vasopressor action of metaraminol is indirect, [6] with metaraminol displacing norepinephrine from neuronal vesicles in order for the noradrenaline to exert these effects. [7] Metaraminol at higher doses may have direct α-adrenergic agonist and β 1-adrenergic agonist effects.