Description
Desmopressin Use:
Desmopressin is a structural analog of the natural peptide hormone of the hypothalamus, arginine-vasopressin, derived from changes in the structure of the vasopressin molecule. The difference consists in the deamination of cysteine (in the 1st position) and replacement of L-arginine (in the 8th position) by D-arginine. This leads to a significant prolongation of the antidiuretic action and a less pronounced effect on the smooth muscle of vessels and internal organs compared to native arginine vasopressin. Desmopressin increases permeability of distal tubule epithelium and increases water reabsorption, which leads to decrease of urine volume, increase of urine osmolarity with simultaneous decrease of blood plasma osmolarity, decrease of frequency of urination and decrease of nocturia (nocturnal polyuria). Antidiuretic effect when administered orally at a dose of 0.1 mg lasts up to 8 hours.
Indications
-Central diabetes mellitus.
-Polyuria/polydipsia after pituitaryectomy or surgery in the “Turkish saddle” area.
– Primary nocturnal enuresis in adults and children over 5 years of age.
-Nockuria in adults associated with nocturnal polyuria (increased urine production at night, exceeding the bladder capacity and causing the need to get up at night more than once to empty the bladder) – as symptomatic therapy.
Contraindications
– Hypersensitivity to desmopressin and/or to any excipient of the drug;
– Habitual or psychogenic polydipsia (with urine volume 40 ml/kg/24 hours);
– Polydipsia in chronic alcoholism;
– Known or suspected chronic heart failure and other conditions requiring prescription of diuretics;
– Hyponatremia, including history;
– Moderate to severe renal insufficiency (creatinine clearance (CK) less than 50 ml/min);
– Syndrome of inadequate production of antidiuretic hormone;
– Childhood under 4 years of age (for treatment of nonsanguineous diabetes) and 5 years of age (for treatment of primary nocturnal enuresis);
– Age 65 years and older when used for symptomatic therapy of nocturia;
– Severe classical Willebrand-Jurgens syndrome (type Pb), in patients with 5% factor VIII activity, presence of antibodies to factor VIII.
How to use and dosages.
- By mouth. The optimal dose of desmopressin is chosen individually. The drug should be taken orally some time after the meal, because food intake can affect absorption of the drug and its effectiveness.
- Diabetes mellitus of central genesis, polyuria/polydipsia after pituitary glandectomy or
- Turkish saddle operations
- At the beginning of treatment the optimal dose of the drug is determined by the doctor individually, taking into account the indicators of osmolarity and urine volume. During the treatment it is necessary to control the duration of sleep and water-electrolyte balance.
- Recommended starting dose for children over 4 years of age and adults is 0.1 mg 3 times per day. Subsequently, the dose is changed depending on the response to treatment. Usually the daily dose is in the range of 0.2-1.2 mg. For most patients, the optimal maintenance dose is 0.1-0.2 mg 3 times a day.
- If signs of fluid retention/hyponatremia occur, treatment should be discontinued and the drug dose taken should be adjusted.
- Primary nocturnal enuresis
- The optimal therapeutic dose is determined individually and adjusted taking into account the patient’s response to treatment. The recommended starting dose is 0.2 mg at night. If there is no effect, the dose may be increased to 0.4 mg. It is necessary to control observance of restriction of fluid intake in the evening. If there are signs of fluid retention/hyponatremia, treatment should be discontinued and the drug dose adjusted.
- The recommended course of continuous treatment is 3 months. The decision to continue treatment should be made on the basis of clinical data that will be observed after discontinuation of the drug for 1 week. Nocturia
- The recommended initial dose is 0.1 mg at night. If there is no effect within 1 week, the dose is increased to 0.2 mg and thereafter to 0.4 mg with increasing doses at a frequency of no more than 1 time per week. If after 4 weeks of treatment and dose adjustment adequate clinical effect is not observed, it is not recommended to continue the drug.
Sandra’s review to this medicine:
