hydrocortisone + vasopressin

Hydrocortisone + vasopressin is a combination therapy used primarily in the management of septic shock, particularly in cases refractory to standard vasopressor support. Hydrocortisone is a synthetic glucocorticoid that exerts anti-inflammatory and immunosuppressive effects by binding to the glucocorticoid receptor, inhibiting phospholipase A2, NF-kappa B, and other inflammatory transcription factors while promoting anti-inflammatory gene expression. Vasopressin is an endogenous peptide hormone that acts as a potent vasoconstrictor by stimulating V1a receptors on vascular smooth muscle cells; it also interacts with V1b (anterior pituitary) and V2 (renal collecting duct) receptors. In septic shock, this combination has been shown to have additive catecholamine-sparing effects—hydrocortisone reduces the required dose and duration of vasopressin needed to maintain blood pressure without altering plasma vasopressin levels. The primary indication for this combination is adjunctive therapy in refractory septic shock.