Desmopressin

Desmopressin has a vasopressor effect.

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Indications Desmopressin

It is used for the following events:

• therapy/diagnosis of diabetes insipidus or diagnosis of renal concentrating capacity;
• transient polyuria;
• intranasal use after surgical procedures on the pituitary gland;
• in combination treatment or monotherapy to eliminate primary urinary incontinence (spray);
• intravenous injections in the treatment of classical hemophilia, as well as von Willebrand-Dian disease (except subtype 2b);
• nocturia.

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Release form

The product is produced in the form of a spray for intranasal use, in a bottle equipped with a dosing nozzle, with a capacity of 5 ml (enough for 50 servings). Inside the box is 1 such bottle.

It is also produced in the form of tablets, 28, 30 or 90 pieces per pack.

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Pharmacodynamics

The active element of the drug activates the V2-terminals of vasopressin, located inside the epithelial tissues of the convoluted tubules, and also inside the ascending limb of the loop of Henle. As a result, water reabsorption into the vessels of the circulatory system is potentiated, and at the same time, the 8th factor of blood coagulation is stimulated.

The antidiuretic effect of the drug is observed with intramuscular and intravenous injections, as well as with intranasal and oral administration. Desmopressin has a low level of toxicity and does not have a mutagenic or teratogenic effect.

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Pharmacokinetics

The half-life of the artificial hormone is 75 minutes. However, the drug in fairly high levels can be observed inside the body for 8-20 hours after use. It has been found that signs of polyuria disappear after 2-3 uses of the drug. Intravenous injections are more effective than intranasal use.

In people with von Willebrand disease, as well as with hemophilia, a single administration of 0.4 mcg/kg of the substance results in a 3-4-fold increase in the 8th factor of blood coagulation. The drug begins to act after 30 minutes from the moment of its use and reaches peak values after 1.5-2 hours.

At the same time, the use of the drug leads to a rapid increase in plasma plasminogen values, although fibrinolysis indices remain the same.

The drug undergoes metabolism within the liver tissue. The disulfide bridge is broken down by the enzyme transhydrogenase.

Excretion of unchanged substance or inactive metabolic products occurs in the urine.

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Dosing and administration

The tablets should be taken orally, several hours after eating (if taken simultaneously, the absorption of the drug may be weakened, which will lead to a decrease in its effectiveness). Portion sizes and duration of therapy are selected by the doctor.

People with diabetes insipidus at the initial stage need to take 0.1 mg of the substance orally 1-3 times a day. After that, it is necessary to individually select the dose, taking into account the effect of the tablets and their tolerability by the patient. On average, the medicinal dosage is 0.1-0.2 mg, taken 1-3 times a day.

The maximum permissible oral dose of the drug per day is 1.2 mg.

In primary nocturnal incontinence, 0.2 mg of the substance is often taken orally at night. If the effect is insufficient, the dose is doubled to 0.4 mg. During treatment, fluid intake should be limited in the 2nd half of the day. On average, continuous therapy lasts 90 days. Taking into account the clinical picture, the doctor can prolong the course (often, before prolonging treatment, the drug is discontinued for 7 days, and then, taking into account the clinical information obtained after the drug is discontinued, they decide whether the patient needs to prolong the course).

Adults with nocturnal polyuria often need to take 0.1 mg of the drug orally at night. If there is no therapeutic result, the dose can be doubled to 0.2 mg. Under the supervision of a doctor, the dosage can continue to increase if necessary. If there are no signs of improvement after 1 month of using the drug, treatment should be discontinued.

The intranasal spray is used in doses of 10-40 mcg/day, which are divided into several separate uses. Children aged at least 3 months and up to 12 years should adjust the daily dose, which is within the range of 5-30 mcg.

The dosage of Desmopressin for intravenous, subcutaneous, and intramuscular injections is 1-4 mcg/day (for adults). Children are allowed to administer 0.4-2 mcg of the drug per day.

If there is no result after 1 week of treatment, it is necessary to adjust the daily dose. It sometimes takes quite a long time – up to several weeks – to select a suitable treatment regimen.

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Use Desmopressin during pregnancy

The use of Desmopressin during lactation or pregnancy is permitted only under the constant supervision of the attending physician.

Contraindications

Main contraindications:

• polydipsia of psychogenic or congenital nature;
• presence of anuria;
• plasma hypoosmolality;
• fluid retention in the body;
• the presence of heart failure with the need to use diuretics;
• allergic reaction to a medication.

It is prohibited to administer the drug intravenously in von Willebrand disease subtype 2b, and in addition in unstable angina

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Side effects Desmopressin

The use of the medication may cause the development of the following side effects:

• headaches, coma, dizziness, loss of consciousness or a feeling of confusion;
• development of a runny nose or hypoosmolality, the appearance of swelling of the nasal mucosa and weight gain;
• increase or decrease in blood pressure (the latter in the case of rapid intravenous injection);
• development of hyponatremia or oliguria, the appearance of edema, and in addition, fluid retention in the body;
• stomach pain, vomiting, intestinal colic and nausea;
• rash on the skin surface and other allergy symptoms, algomenorrhea, and hot flashes;
• problems with lacrimation and conjunctivitis of allergic origin;
• pain at the injection site.

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Overdose

Poisoning with the drug often causes fluid retention and the development of symptoms of hyponatremia.

In these cases, it is necessary to administer an isotonic or hypertonic solution of sodium chloride intravenously, and also prescribe the patient a diuretic (furosemide).

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Interactions with other drugs

Combination with dopamine, especially in high doses, may potentiate the pressor effect.

Indomethacin affects the intensity of the medicinal effect of Desmopressin.

Combining the drug with lithium carbonate leads to a decrease in its antidiuretic properties.

The drug should be combined with caution with medications that enhance the release of antidiuretic hormone: such as carbamazepine with chlorpromazine, phenylephrine with tricyclics and epinephrine. Such a combination can cause potentiation of the vasopressor effect of the drug.

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Storage conditions

Desmopressin should be kept in a dark place, out of reach of children. Temperature indicators – within 15-25°C.

Shelf life

Desmopressin tablets can be used for 30 months from the date of manufacture of the drug. The shelf life of the spray is 2 years.

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Application for children

The daily portion size for children under 12 years of age needs to be adjusted.

In infants under 1 year of age, intoxication with the substance can lead to the development of seizures due to the irritating effect of the drug on the nervous system.

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Analogues

Analogues of the substance are the drugs Vazomirin, Minirin and Emosint with Presainex, and in addition to this, Adiuretin, desmopressin acetate, Nourem with Nativa, Apo-Desmopressin and Adiuretin SD.

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Reviews

Desmopressin receives positive reviews for the treatment of nocturnal enuresis in children, although it is noted that the effect of its use does not develop immediately, but after several weeks. At the same time, the comments speak of good tolerability of the drug.

There are also reviews about the drug's effective action in diabetes insipidus - its use improves the patient's condition, alleviating the symptoms of the disease.