Arginine Vasopressin (AVP)
Evidence: B/C — Meaningful Human EvidenceRenal / Fluid-Balance Signaling
Evidence Snapshot
What this grade covers
B applies to direct human pharmacologic/hemodynamic evidence for exact-sequence AVP: a large, real multicenter RCT (VASST, PMID 18305265, N=778) directly comparing AVP infusion to norepinephrine in septic shock, a smaller RCT in advanced vasodilatory shock (PMID 12732600, N=48), a controlled human chronic-infusion osmoregulation/fluid-balance physiology study (PMID 8222513), and an FDA-approved exact-sequence synthetic AVP product (Vasostrict) with its own labeled indication, dosing, and safety data for vasodilatory shock. C applies specifically to any generalized therapeutic-superiority or mortality-benefit claim: VASST's own primary 28-day mortality endpoint was statistically null, and the positive 90-day 'less severe shock' subgroup finding is hypothesis-generating, not confirmatory. This grade does not extend to Copeptin diagnostic evidence (a distinct Batch 16 Current subject) and does not extend AVP's grade to Desmopressin, Terlipressin, or Lypressin, all of which are separately graded analogue-programme subjects.
Regulatory Context
Native AVP is an endogenous hormone, not itself an FDA-approved drug. A synthetic, exact-sequence AVP product (Vasostrict, vasopressin injection) is FDA-approved specifically for vasodilatory shock refractory to fluids/catecholamines; this is a product-specific approval and does not mean every AVP-labeled or compounded preparation is FDA approved.
Research Takeaway
Arginine Vasopressin (AVP) is the mature 9-amino-acid neurohypophyseal hormone, distinct from its prepro-AVP precursor, neurophysin II, and Copeptin, all three of which are co-secreted cleavage products of the same precursor rather than AVP itself.
Evidence boundary: Co-secretion and shared ancestry do not make precursor fragments interchangeable with mature AVP for identity or efficacy purposes.
See all 7 evidence claims →Quick Summary
Arginine Vasopressin (AVP) is the body's principal antidiuretic/osmoregulatory hormone and, as the synthetic exact-sequence product Vasostrict, an FDA-approved vasopressor for refractory vasodilatory shock. Direct human evidence includes a large randomized trial (VASST) and controlled physiology studies, but VASST's own primary mortality endpoint was negative — AVP raises blood pressure in this setting without proven survival benefit over standard care.
Mechanism & Research Overview
Arginine Vasopressin (AVP) is the body's principal antidiuretic/osmoregulatory hormone and, as the synthetic exact-sequence product Vasostrict, an FDA-approved vasopressor for refractory vasodilatory shock. Direct human evidence includes a large randomized trial (VASST) and controlled physiology studies, but VASST's own primary mortality endpoint was negative — AVP raises blood pressure in this setting without proven survival benefit over standard care.
Evidence Claims
Individual scientific statements drawn from the sources cited below, each shown with the specific evidence boundary that statement does not establish.
Supported
Arginine Vasopressin (AVP) is the mature 9-amino-acid neurohypophyseal hormone, distinct from its prepro-AVP precursor, neurophysin II, and Copeptin, all three of which are co-secreted cleavage products of the same precursor rather than AVP itself.
Does not establish
Evidence boundary: Co-secretion and shared ancestry do not make precursor fragments interchangeable with mature AVP for identity or efficacy purposes.
Supported
Exact-sequence AVP, infused intravenously, raises blood pressure and produces measurable hemodynamic effects in catecholamine-refractory vasodilatory/septic shock, evaluated in randomized controlled human trials.
Sources: Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock; Arginine Vasopressin in Advanced Vasodilatory Shock: A Prospective, Randomized, Controlled Study
Supported
VASST did not show a statistically significant reduction in 28-day mortality for AVP versus norepinephrine in septic shock; a subgroup signal in less-severe shock was not the trial's primary, confirmed result.
Does not establish
Evidence boundary: A single subgroup finding must not be presented as an established mortality benefit.
Sources: Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock
Supported
Exogenous low-dose AVP infusion measurably alters renal water handling and blunts the renin response to sodium restriction in healthy human volunteers, consistent with AVP's endogenous antidiuretic/osmoregulatory role.
Supported
Vasostrict (vasopressin injection) is an FDA-approved, synthetic, exact-sequence AVP product indicated to increase blood pressure in adults with vasodilatory shock; this approval is product-specific and does not constitute approval of AVP for any other use.
Sources: FDA Label / DailyMed Record for Vasostrict (Vasopressin Injection)
Supported
Administered AVP carries dose-related ischemic and cardiac risk (coronary/mesenteric/skin/digital ischemia, decreased cardiac output, bradycardia, tachyarrhythmia, hyponatremia), per its own FDA label and its clinical-trial adverse-event profile.
Sources: FDA Label / DailyMed Record for Vasostrict (Vasopressin Injection); Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock
Supported
No controlled AVP evidence in this manifest establishes AVP as superior to standard vasopressors for mortality outcomes in unselected septic/vasodilatory shock; VASST's primary endpoint was negative.
Sources: Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock
Safety & Evidence Limitations
Considerations reported in the sources cited on this page — not a complete list of every possible risk, and not medical advice.
Higher-Priority Safety Consideration
Coronary, mesenteric, skin, and digital ischemia; decreased cardiac output; bradycardia; tachyarrhythmia — all documented in Vasostrict's label and consistent with VASST/PMID 12732600 trial safety reporting.Safety Consideration
Reported adverse effect in AVP clinical trial and label safety data; distinct mechanism from — but analogous in category to — Desmopressin's larger, better-characterized hyponatremia signal (see Desmopressin page; not a cross-subject grade transfer).Safety Consideration
The largest AVP-vs-norepinephrine RCT did not show a mortality benefit; positive subgroup findings are hypothesis-generating only.Safety Consideration
Vasostrict's approval is scoped to vasodilatory shock refractory to fluids/catecholamines, not a general blood-pressure agent.
Research Areas Being Studied
Research areas discussed on this page reflect the Renal / Fluid-Balance Signaling category and the sources cited below.
Findings Reported in Studies
Educational summary only — reported in cited studies, not a claim of proven benefit.
- Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock (2008):
- Arginine Vasopressin in Advanced Vasodilatory Shock: A Prospective, Randomized, Controlled Study (2003):
- Effect of chronic low-dose arginine vasopressin infusion on body fluid homoeostasis during adaptation from a high- to a low-sodium diet in normal man (1993):
Study Tables by Evidence Type
Human Studies & Clinical Data
| Title | Year | Population / Model | Dose / Duration / Finding | Safety Notes | Source |
|---|---|---|---|---|---|
| Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock | 2008 | 778 adults with septic shock (multicenter, double-blind RCT — VASST) | Low-dose arginine vasopressin (0.01-0.03 U/min) added to open-label vasopressors was not statistically superior to norepinephrine (5-15 mcg/min) for the primary 28-day mortality endpoint (35.4% AVP vs. 39.3% norepinephrine; RR 0.90, 95% CI 0.75-1.08, P=0.26). | A prespecified 'less severe septic shock' subgroup showed lower 90-day mortality with AVP (35.8% vs 46.1%, P=0.04) — a hypothesis-generating subgroup signal, not the trial's primary, confirmed result. | |
| Arginine Vasopressin in Advanced Vasodilatory Shock: A Prospective, Randomized, Controlled Study | 2003 | N=48, advanced vasodilatory shock | Arginine vasopressin infusion produced measurable hemodynamic effects in advanced vasodilatory shock in a controlled human trial. | ||
| Effect of chronic low-dose arginine vasopressin infusion on body fluid homoeostasis during adaptation from a high- to a low-sodium diet in normal man | 1993 | Healthy human volunteers | Constant low-dose AVP infusion (6 fmol/min/kg) blunted the natural diuresis and blunted the rise in plasma renin activity that otherwise accompanies dietary sodium restriction. |
Animal / Cell / Preclinical Data
No Animal / Cell / Preclinical Data Listed Yet
This section will be updated as sources are added.
Regulatory Documents & Official Trial Registries
| Title | Year | Population / Model | Dose / Duration / Finding | Safety Notes | Source |
|---|---|---|---|---|---|
| FDA Label / DailyMed Record for Vasostrict (Vasopressin Injection) | Vasostrict (vasopressin injection) is a sterile aqueous solution of synthetic arginine vasopressin, exact 9-residue AVP sequence (Cys-Tyr-Phe-Gln-Asn-Cys-Pro-Arg-Gly-NH2, cyclo 1-6), FDA-approved to increase blood pressure in adults with vasodilatory shock (e.g., post-cardiotomy or sepsis) who remain hypotensive despite fluids and catecholamines. Labeled dosing 0.01-0.07 units/min titration. | Labeled adverse-event profile includes bradycardia, tachyarrhythmia, hyponatremia, and coronary/mesenteric/skin/digital ischemia. | No source link available |
Anecdotal Reported Patterns — Not Medical Advice
Anecdotal Reported Patterns — Not Medical Advice
Reported dosing patterns are included for educational context only. They are self-reported, unverified, not medical advice, and not instructions for human use. Community-submitted patterns are not yet available in this Phase 1 prototype; this section is a placeholder reserved for moderated, aggregated community data.
Lab Markers to Discuss With a Clinician
Educational topics only — not self-monitoring instructions.
FAQ
Disclaimer
Educational information only. This page summarizes published research and official regulatory information about Arginine Vasopressin and does not provide medical advice, an individualized treatment recommendation, or dosing instructions.
Educational use only. This content is provided for informational and research-summary purposes only. It is not medical advice, not a treatment recommendation, not a dosing guide, and not a substitute for care from a licensed medical professional. Nothing here is intended to diagnose, treat, cure, prevent, or mitigate disease. Reported dosing patterns, when shown elsewhere on the site, must be labeled either as Study / Trial Dosing or Anecdotal Reported Patterns — Not Medical Advice. Community reports are self-reported, unverified, and not scientific proof.
Community-reported experiences, once enabled, must be displayed only as moderated, anonymized, or aggregated data. They are anecdotal, self-reported, unverified, and should never be presented as proof of safety, efficacy, or expected results.
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