Drugs List

Therapeutic Indications

Uses

Neurohypophyseal diabetes insipidus - short term therapy for prevention and control of polydipsia, polyuria and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous posterior pituitary antidiuretic hormone.

Control of bleeding from oesophageal varices.

Unlicensed Uses

Adjunct in acute massive haemorrhage of gastrointestinal tract or oesophageal varices in children.

Administration

Argipressin may be given by subcutaneous, intramuscular or intravenous injection.

Reconstitution

For intravenous administration in the control of oesophageal varices, further dilution into a larger volume is required.

Compatibilities

Glucose injection 5%
Sodium chloride injection 0.9%

Contraindications

Chronic nephritis with nitrogen retention (until nitrogen blood levels normalised)
Vascular disorder
Hypertension

Precautions and Warnings

Use with extreme caution in patients with vascular disease (especially disease of the coronary arteries) and systemic hypertension. With large doses myocardial infarction may occur and even small doses may precipitate pain.
If used in patients with peripheral vascular disease, the skin should be observed carefully for signs of ischaemia.

Use with caution in the following conditions as rapid addition of extracellular water may be hazardous:
Epilepsy
Migraine
Asthma
Heart failure
Renal impairment
Pregnancy (see Pregnancy section)

Fluid intake should be adjusted to avoid hyponatraemia and water intoxication.

Monitor for early signs of water intoxication, such as drowsiness, listlessness and headaches, to prevent terminal coma and convulsions

May cause vertigo. Advise patients not to drive or operate machinery if affected

Pregnancy and Lactation

Pregnancy

Argipressin has been used successfully for the treatment of diabetes insipidus during pregnancy and no adverse effects on the foetus has been reported.

Briggs (2011) states that a three fold increase of circulating levels of endogenous vasopressin has been reported for women in the last trimester and in labour compared with nonpregnant women. The induction of uterine activity (oxytocic effect) has been reported after of administration intramuscular and intranasal vasopressin.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Argipressin has been administered to breast feeding women without apparent adverse effects on the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Tremor
Sweating
Vertigo
Pallor
Throbbing headache
Nausea
Vomiting
Abdominal cramps
Eructation
Flatulence
Desire to defaecate
Hypersensitivity reactions
Anaphylaxis
Constriction of coronary arteries
Anginal pain
Myocardial ischaemia
Myocardial infarction
Peripheral ischaemia
Gangrene
Water intoxication
Urticaria
Bronchoconstriction
Fluid retention

Presentation

Solution for injection containing 0.4mg/ml of argipressin (arginine vasopressin) which is equivalent to 20 international units per ml.

Drugs List

Therapeutic Indications

Uses

Neurohypophyseal diabetes insipidus - short term therapy for prevention and control of polydipsia, polyuria and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous posterior pituitary antidiuretic hormone.

Control of bleeding from oesophageal varices.

Unlicensed Uses

Adjunct in acute massive haemorrhage of gastrointestinal tract or oesophageal varices in children.

Dosage

Dosage should be individually determined as required.

Dosing should be carried out under specialist management only.

Adults

Elderly

Children

Patients with Renal Impairment

Administration

Argipressin may be given by subcutaneous, intramuscular or intravenous injection.

Reconstitution

For intravenous administration in the control of oesophageal varices, further dilution into a larger volume is required.

Compatibilities

Glucose injection 5%
Sodium chloride injection 0.9%

Contraindications

Chronic nephritis with nitrogen retention (until nitrogen blood levels normalised)
Vascular disorder
Hypertension

Precautions and Warnings

Use with extreme caution in patients with vascular disease (especially disease of the coronary arteries) and systemic hypertension. With large doses myocardial infarction may occur and even small doses may precipitate pain.
If used in patients with peripheral vascular disease, the skin should be observed carefully for signs of ischaemia.

Use with caution in the following conditions as rapid addition of extracellular water may be hazardous:
Epilepsy
Migraine
Asthma
Heart failure
Renal impairment
Pregnancy (see Pregnancy section)

Fluid intake should be adjusted to avoid hyponatraemia and water intoxication.

Monitor for early signs of water intoxication, such as drowsiness, listlessness and headaches, to prevent terminal coma and convulsions

May cause vertigo. Advise patients not to drive or operate machinery if affected

Pregnancy and Lactation

Pregnancy

Argipressin has been used successfully for the treatment of diabetes insipidus during pregnancy and no adverse effects on the foetus has been reported.

Briggs (2011) states that a three fold increase of circulating levels of endogenous vasopressin has been reported for women in the last trimester and in labour compared with nonpregnant women. The induction of uterine activity (oxytocic effect) has been reported after of administration intramuscular and intranasal vasopressin.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Argipressin has been administered to breast feeding women without apparent adverse effects on the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Effects on Ability to Drive and Operate Machinery

No specific tests on the ability to drive or operate machinery have been conducted. However side effects such as vertigo have been reported and may affect the ability to perform skilled tasks such as driving or operation of machinery.

Counselling

Advise patients of the possible effects of vertigo which may affect their ability to drive or operate machinery.

Side Effects

Tremor
Sweating
Vertigo
Pallor
Throbbing headache
Nausea
Vomiting
Abdominal cramps
Eructation
Flatulence
Desire to defaecate
Hypersensitivity reactions
Anaphylaxis
Constriction of coronary arteries
Anginal pain
Myocardial ischaemia
Myocardial infarction
Peripheral ischaemia
Gangrene
Water intoxication
Urticaria
Bronchoconstriction
Fluid retention

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Shelf Life and Storage

Store at 2-8 degrees C.
Do not freeze.

Further Information

Last Full Review Date: June 2012

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Argipressin 20 IU/ml Solution for Injection. Mercury Pharma Group. Revised May 2012.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 17 August 2017