Products Affected - Description

Reason for the Shortage

• American Regent had temporarily suspended manufacture of most drug products including vasopressin injection in April, 2011.¹
• American Regent resumed manufacturing in Shirley, New York in early-May, 2011.²
• American Regent recalled 17 lots of vasopressin in August, 2011 due to potential for decreased potency. 
• JHP had Pitressin on shortage due to increased demand for the product.³
• APP had vasopressin on shortage due to increased demand for the product.⁴

Available Products

Estimated Resupply Dates

• American Regent has vasopressin 20 units/mL 0.5 mL, 1 mL, and 10 mL vials on back order and the company cannot estimate a release date.^1,2

Implications for Patient Care

• Vasopressin is an unapproved drug. Vasopressin injection is a synthetic 8-arginine vasopressin, an antidiuretic hormone released from the posterior pituitary gland. Vasopressin injection is labeled for use in diabetes insipidus, for the prevention and treatment of postoperative abdominal distention, and to dispel gas that may interfere with interpretation of abdominal roentgenography.^5,6,7
• Unlabeled uses of vasopressin include adjunctive treatment of gastrointestinal or esophageal variceal hemorrhage, pulseless cardiac arrest, vasodilatory or septic shock, and for donor management in brain-dead patients.^6,7,8

Safety

• To avoid dosing errors, be aware that vasopressin is dosed in units and desmopressin is dosed in micrograms.^5,9
• Vasopressin and desmopressin have different indications and actions.^5,7,9

Alternative Agents & Management

• Desmopressin acetate (DDAVP) is another antidiuretic peptide available in the US. Desmopressin is labeled for treatment of diabetes insipidus, primary nocturnal enuresis, Hemophilia A, and von Willebrand disease.⁹
• Desmopressin acetate has greater vasopressin receptor V₂ selectivity compared with vasopressin and has greater anti-diuretic potency. However, desmopressin has less vasopressin receptor V₁ activity, which results in lower vasopressor and smooth muscle contracting activity compared to vasopressin. Desmopressin increases Factor VIII activity to a greater degree than vasopressin in patients with hemophilia A or von Willebrand Disease.⁷
• Table 1 lists alternatives to vasopressin in specific situations.
• Vasopressin is used as hormone replacement therapy in brain-dead patients who are organ donors. Vasopressin is part of the United Network for Organ Sharing (UNOS) standardized donor management protocol.¹⁰ Institutions may want to consider conserving product for this indication.

Related Shortages

• Desmopressin Injection
• Desmopressin Rhinal Tubes— Resolved

1. American Regent (personal communications). May 13 and October 24, 2011.
2. American Regent Product Releases. Available online. Accessed June 23, July 12 and 22, August 29, September 20, and October 26, 2011; January 11, February 16, March 12, April 4 and 17, May 17, June 15, July 5 and 12, August 27, October 16, and December 4, 2012; January 16, February 13, March 29 and April 29, 2013.
3. JHP (personal communications). May 16, June 7 and 20, July 22, August 30, September 21, and October 24, 2011; January 11, February 16, March 12, April 4 and 17, May 16, June 15, July 5 and 11, August 27, October 16, and December 4, 2012; January 16, February 13, and March 29, 2013.
4. APP (personal communications). May 16, June 7, July 12, August 30, September 16, and October 24, 2011; January 11, February 15, March 9, April 4 and 17, May 14, June 12, July 3 and 9, August 27, October 16, and December 4, 2012; January 16, February 13,  March 29, April 23, and May 7, 2013.
5. JHP Pharmaceuticals. Pitressin (Vasopressin) Injection Synthetic [product information]. Rochester, MI: JHP Pharmaceuticals; January 2010.
6. Baughman VL, Golembiewski J, Gonzales JP, Alvarez W, eds. Anesthesiology and Critical Care Drug Handbook. 9^th ed. Hudson, OH: Lexi-Comp; 2010.
7. McEvoy GK, Snow EK, Kester L, Litvak K, Miller J, Welsh OH, eds. AHFS DI (Lexi-Comp Online). Bethesda, MD: American Society of Health-System Pharmacists; 2011.
8. Wickersham RM, Novak KK, managing eds., eds. Drug Facts and Comparisons (eFacts). St. Louis, MO: Wolters Kluwer Health, Inc.; 2011.
9. Sanofi-Aventis. DDAVP (Desmopressin) Injection [product information]. Bridgewater, NJ: Sanofi-Aventis; July 2007.
10. United Network for Organ Sharing. Critical Pathway for Organ Donor. Available online.  Accessed May 19, 2011.
11. Anon. Drug Evaluation: Vasopressin. In: Hutchison TA, Shahan DR, Anderson ML, eds. Drugdex System [internet database]. Greenwood Village, CO: Thomson Healthcare; 2011. Updated periodically.
12. Bauer SR, Lam SW. Arginine vasopressin for the treatment of septic shock in adults. Pharmacotherapy. Oct;30(10):1057-1071.
13. Dictus C, Vienenkoetter B, Esmaeilzadeh M, Unterberg A, Ahmadi R. Critical care management of potential organ donors: our current standard. Clin Transplant. Dec 2009;23 Suppl 21:2-9.
14. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. Sep 2007;46(3):922-938.
15. Maybauer MO, Walley KR. Best vasopressor for advanced vasodilatory shock: should vasopressin be part of the mix? Intensive Care Med. Sep;36(9):1484-1487.
16. Shah VR. Aggressive management of multiorgan donor. Transplant Proc. May 2008;40(4):1087-1090.
17. Fauci AS, Braunwald E, Kasper DL, et al., eds. Harrison's Principles of Internal Medicine. 17^th ed. New York, NY: McGraw-Hill; 2008.

Updated

Updated May 7, 2013 by David M. Peterson, PharmD, Drug Information Specialist. Created May 19, 2011 by Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2013, Drug Information Service, University of Utah, Salt Lake City, UT.