Vasopressin

Arginine vasopressin, AVP, antidiuretic hormone (ADH), argipressin, 8-arginine vasopressin; Vasostrict, Pitressin (historical)

Sexual health, hormones & signalling

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Note on this profile. Vasopressin is a naturally occurring hormone and, as an injectable, an approved prescription medicine used almost entirely in intensive care. This page explains the published science, including small intranasal research studies on social behaviour. Intranasal use outside a trial is unapproved, and the molecule's blood-vessel-constricting action is not trivial.

Summary

Class: Naturally occurring 9-amino-acid cyclic peptide hormone (nonapeptide) made in the hypothalamus and released from the posterior pituitary
Mechanism: Activates V1a receptors (blood-vessel constriction, brain social circuits), V1b receptors (pituitary ACTH release) and V2 receptors (water retention in the kidney, vWF release)
Routes studied: Intravenous infusion (approved); intranasal (research, 20–40 IU); historical IM/SC for diabetes insipidus
Dose range reported: Approved (Vasostrict): vasodilatory shock 0.01–0.03 units/min IV, titrated; up to 0.1 units/min after cardiac surgery. Research intranasal: 20–40 IU single dose in adults; up to 24 IU/day for 4 weeks in children with autism (Parker 2019). Community: unspecified intranasal doses
Half-life: 10–20 minutes in plasma
Storage: Vials: refrigerate 2–8 °C; may be held at room temperature for a limited period per label; diluted infusions used within 18–24 h
Regulatory status: Approved medicine (IV) in US, EU, UK, AU, ZA; intranasal use unapproved everywhere

Doses are as reported in studies or by the community — never recommendations.

1What it is

Vasopressin is one of the body's two posterior-pituitary hormones (the other is oxytocin, which differs by two amino acids). It controls water balance by telling the kidneys to concentrate urine, raises blood pressure when the circulation is under threat, and acts within the brain on social recognition, aggression, pair-bonding and stress responses, work largely based on rodents and voles. As a medicine it has been used since the early twentieth century (as pituitary extract and later synthetic Pitressin) and was formally FDA-approved as Vasostrict in 2014 for shock that does not respond adequately to fluids and catecholamines. Desmopressin (this batch) is its engineered, kidney-selective descendant.

2How it's thought to work

V1a (vascular smooth muscle). constricts arterioles, raising blood pressure by a mechanism independent of adrenergic receptors, which is why it still works when noradrenaline responsiveness is blunted in septic shock. Vasopressin levels are inappropriately low in prolonged septic shock, and low-dose infusion restores them.

V2 (kidney and endothelium). water retention and release of von Willebrand factor and factor VIII.

V1b (pituitary). potentiates ACTH and therefore cortisol release during stress.

Brain V1a. in rodents, AVP promotes social recognition, territorial aggression and (in male prairie voles) pair bonding. Human intranasal studies try to probe the same circuits; whether and how much intranasal AVP reaches the brain is still debated.

The natural hormone at two receptors: V2 in the kidney, which moves water channels to the surface so water is reabsorbed, and V1a on vessels, which narrows them.Schematic — not to scale

3What the research shows

Vasodilatory (septic) shock

VASST (n=778) found no overall mortality difference between low-dose vasopressin added to noradrenaline and noradrenaline alone, with a possible benefit in less severe shock (Russell 2008, NEJM). VANISH (n=409) found no difference in kidney-failure-free days but less renal replacement therapy with vasopressin (Gordon 2016, JAMA). Meta-analysis suggests lower rates of atrial fibrillation (Nagendran 2019, Intensive Care Med). Guidelines recommend adding vasopressin at 0.03 units/min when noradrenaline requirements climb. [1][2][3]

Graded A (negative)

Cardiac arrest

Vasopressin did not improve survival over adrenaline and was removed from most resuscitation algorithms in 2015; a later trial of vasopressin plus methylprednisolone in in-hospital arrest increased return of spontaneous circulation but not survival (Andersen 2021, JAMA).

Graded A (small)

Social cognition and behaviour (intranasal)

Single-dose crossover studies in healthy adults report sex-specific changes in how people perceive faces (men saw neutral faces as less friendly and showed more agonistic facial responses; women the opposite — Thompson 2006, PNAS), enhanced memory for emotional faces (Guastella 2010, Biol Psychiatry), altered cooperation and risky cooperative behaviour (Rilling 2012, Psychoneuroendocrinology; Brunnlieb 2016, PNAS). Effects are small, sometimes contradictory, and in groups of 20–60 people. [4][5][6]

Graded A (small pilot)

Autism

A 4-week placebo-controlled trial in 30 children with autism reported improved social abilities on a parent-rated scale with intranasal vasopressin (Parker 2019, Sci Transl Med). Single site, small, awaiting replication; a larger trial is under way. [7]

Graded B (historical)

Diabetes insipidus, bleeding varices, abdominal distension

Older uses now replaced by desmopressin and terlipressin/octreotide respectively.

Memory and "nootropic" use

1970s–80s studies used lysine-vasopressin or desmopressin, not AVP, and were inconclusive. Community interest in intranasal AVP for memory or social confidence rests on rodent data and anecdote.

4Reported side effects and interactions

Literature-reported

IV (literature). reduced cardiac output, bradycardia and arrhythmias, myocardial, mesenteric and digital ischaemia (skin and finger necrosis at higher doses), hyponatraemia from water retention, pallor, nausea, abdominal cramps, bronchoconstriction, tremor, vertigo; extravasation causes local tissue damage. Rare anaphylaxis.

Intranasal (research). generally well tolerated in single doses: nasal irritation, headache, mild blood-pressure rise reported in some studies; no serious events in the autism pilot, but the data set is small.

Community-reported

headache, nasal stinging, flushing, "wired" or anxious feelings, reduced urination; a few reports of palpitations.

Theoretical. coronary vasoconstriction in people with ischaemic heart disease; water retention and low sodium with high fluid intake; raised cortisol via V1b; effects on mood and aggression in either direction.

Interactions. additive pressor effect with catecholamines and other vasoconstrictors; drugs that potentiate antidiuretic effect (carbamazepine, chlorpropamide, tricyclics, SSRIs, fludrocortisone) raise hyponatraemia risk; lithium, demeclocycline and heparin reduce the antidiuretic effect; ganglionic blockers and furosemide increase the pressor response (per label).

Markers researchers commonly monitor

For IV use these are intensive-care measures; for intranasal research, the relevant markers are simple:

Marker	Why it's watched
Serum sodium and osmolality	water retention is the predictable risk of any vasopressin exposure with free fluid intake.
Blood pressure and heart rate	the drug's primary effect; a home cuff before and after a dose is the minimum.
Urine output / frequency	reduced output is the first sign of antidiuretic action.
ECG and troponin	ischaemia and arrhythmia in IV use, or in anyone with cardiac history.
Lactate and capillary refill / digital perfusion	ICU markers of excessive vasoconstriction.
Cortisol (morning)	V1b-mediated ACTH release is plausible with repeated dosing; a baseline is reasonable.
Copeptin	the measurable surrogate of endogenous vasopressin release, useful in research but not routine.

Free for everyone. Safety information is never behind a paywall.

5Reconstitution and handling

Approved vials (20 units/mL) are diluted into saline or dextrose for infusion in hospital; no community-style applies. Vasopressin is dosed in units (1 unit ≈ 2.5 µg), which is a frequent source of confusion when people read research papers quoting IU alongside microgram labelling on research-grade vials. (unit conversions only)

Open in calculator, pre-loaded →

6Commonly studied alongside

Oxytocin (its sister hormone; most intranasal social-cognition studies test both), desmopressin (kidney-selective analogue, this batch), noradrenaline and hydrocortisone (shock protocols, not peptides), terlipressin (longer-acting analogue used for variceal bleeding and hepatorenal syndrome).

Informational cross-links. Not stack recommendations.

7Regulatory status by region

Region	Status (checked —)
United States	FDA-approved (Vasostrict and generics) for increasing blood pressure in vasodilatory shock; intranasal use unapproved
European Union	Authorised nationally (argipressin, e.g. Empressin, Reverpleg) for catecholamine-refractory shock
United Kingdom	MHRA-licensed argipressin injection; hospital use
Australia	TGA-approved vasopressin injection; hospital use
South Africa	SAHPRA-registered; hospital use
Sport	Not specifically listed by WADA as of review date; its analogue desmopressin is listed under S5 †

8Open questions

Does intranasal vasopressin reach human brain targets at the doses used, and do the social-cognition findings replicate?
Will the autism pilot result hold in larger multi-site trials?
Which septic-shock patients benefit from early vasopressin, and does it protect the kidney?

9References

1Russell JA et al. (2008). Vasopressin versus norepinephrine infusion in patients with septic shock (VASST). N Engl J Med. PubMed · DOI
2Gordon AC et al. (2016). Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: the VANISH randomized clinical trial. JAMA. PubMed · DOI
3Nagendran M et al. (2019). Vasopressin in septic shock: an individual patient data meta-analysis of randomised controlled trials. Intensive Care Med. PubMed · DOI
4Thompson RR et al. (2006). Sex-specific influences of vasopressin on human social communication. Proc Natl Acad Sci USA. PubMed · DOI
5Guastella AJ et al. (2010). Intranasal arginine vasopressin enhances the encoding of happy and angry faces in humans. Biol Psychiatry. PubMed · DOI
6Rilling JK et al. (2012). Effects of intranasal oxytocin and vasopressin on cooperative behavior and associated brain activity in men. Psychoneuroendocrinology. PubMed · DOI
7Parker KJ et al. (2019). A randomized placebo-controlled pilot trial shows that intranasal vasopressin improves social deficits in children with autism. Sci Transl Med. PubMed · DOI
8Vasostrict prescribing information (current label). PubMed

References are being resolved to PubMed/DOI identifiers; links search PubMed for the citation until then.

† Being confirmed by our reviewers against current sources.

10Community

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11Page history

26 Oct 2026Profile published — awaiting medical review

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