A note on rebound hypotension post vasopressin drip

Vasopressin has been used with different doses in different ICUs depending on local culture - and this is mostly due to the fact that vasopressin has dose dependent effect. Dose for vasopressin is not recommended beyond  0.03 units/min but definitely higher dose has been shown to be more effective to counter hypotension. Though at least one study has shown its safety upto dose of 0.06 units/min but general consensus is to avoid it beyond 0.03 units/min as coronary, dermal and mesenteric ischemia has been clearly associated with use of vasopressin. One seldom mentioned aspect of vasopressin therapy is rebound hypotension at the abrupt discontinuation of drip. Drip should be titrated down very slowly by 0.01 units/min.



References:

1. Polito A, Parisini E, Ricci Z, et al. Vasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis. Intensive Care Med 2012; 38:9. 

2. Malay MB, Ashton JL, Dahl K, et al. Heterogeneity of the vasoconstrictor effect of vasopressin in septic shock. Crit Care Med 2004; 32:1327. Kahn JM, Kress JP, Hall JB. 

3. Dünser MW, Mayr AJ, Tür A, et al. Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: incidence and risk factors. Crit Care Med 2003; 31:1394.