Thoughts on vasopressin

In our facility, ACEI/ARBs are frequently not held and sometimes are even given DOS. Hell, entresto was given 30 mins before induction in my most recent case. Unless I see a significant reaction from NEO within 200-500mcgs, I’ve just gone straight to Vaso pushes as second line for vasoplegia r/t acei/arbs. I’ve had several people tell me vaso is a nasty drug and that I shouldn’t be using it.

I’ve also learned Vaso is $8/20 units vs $50/50mg ephedrine at the place I work.

What’s your thoughts? Struggle with Neo at med/high gtt and lots of ephedrine or < 10 units of vasopressin over several hours to supplement Neo. (I know the real answer is get the drugs held but this is a massive facility problem that won’t be fixed soon).