Desmopressin - instructions for use, dose, side effects, contraindications

Synthetic analogue of vasopressin. Has a pronounced antidiuretic effect. In comparison with vasopressin, it affects to a lesser degree the smooth muscles of blood vessels and internal organs. In contrast, vasopressin acts longer and does not increase blood pressure. When diabetes insipidus improves the reabsorption of water from the distal tubule of the kidneys, while simultaneously increasing the relative osmotic density of urine. This helps to reduce the frequency of urination and eliminate the increased need for fluids.

Desmopressin activates the factor VIII of blood clotting and promotes an increase in the plasma activator level of plasmin.

The drug stimulates V₁-receptors of vasopressin, which leads to a reduction in the smooth muscles of the gastrointestinal tract and vessels, and also stimulates V₂-vasopressin receptors, which leads to an increase in the reabsorption of water in the kidneys and increases the activity of clotting factors.

Pharmacokinetics:

The maximum antidiuretic effect occurs when ingested after 4-7 hours. After intranasal application, the absorption is 10-20%. The maximum concentration of active substance in the plasma is achieved after 0.5-4 hours. Desmopressin is destroyed in the gastrointestinal tract. The drug is metabolized in the kidneys, the half-life - the fast phase - is 7-8 minutes, the half-life - a long phase - with intranasal application is 75.5 minutes.

Indications:

Polyuria / polydipsia of the central genesis, primary nocturnal enuresis, hypocoagulation, diabetes insipidus of central origin, diagnosis of diabetes insipidus, evaluation of the secretion of antidiuretic hormone, hemophilia of mild / moderate severity,von Willebrand disease.

ICD-10

III.D65-D69 Blood clotting disorders, purpura and other hemorrhagic conditions

III.D65-D69.D68.0 Von Willebrand's Disease

III.D65-D69.D68.8 Other specified disorders of coagulation

IV.E20-E35.E23.2 Non-diabetes mellitus

XIV.N30-N39.N39.4 Other specified incontinence

XVIII.R30-R39.R32 Urinary incontinence, unspecified

XVIII.R30-R39.R35 Polyuria

Contraindications:

Reduced osmotic density of blood plasma, fluid retention in the body (any etiology), anuria, hypersensitivity, inbirth or psychogenic polydipsia, heart failure and other conditions requiring diuretic therapy, hyponatremia, renal failure of moderate to severe severity, inadequate antidiuretic hormone production syndrome, children under 4 years old (for diabetes mellitus) and 5 years (for treatment primary nocturnal enuresis).

For intravenous administration: unstable angina, Willebrand type IIB disease.

Carefully:

Violation of kidney function, fibrosis of the bladder, violations of water and electrolyte balance, cystic fibrosis, dehydration, tendency to thrombosis,potential risk of increased intracranial pressure, during pregnancy, in patients with cardiovascular disease; with bronchial asthma, epilepsy and migraine in the anamnesis; in patients older than 65 years (if necessary, reduce the dose of the drug).

Pregnancy and lactation:

Category Food and Drug Administration (US Food and Drug Administration) - B. Adequate and strictly controlled safety studies of the use of desmopressin during pregnancy and lactation were not conducted. If desmopressin is needed in this category of patients, the expected benefit of therapy for the mother and the possible risk to the fetus or the child should be weighed. Penetrates into breast milk. Violations are not registered.

Dosing and Administration:

Subcutaneously / intravenously / intramuscularly - 1-4 mg per day for adults; 0.4 mcg per day for children.

Intranasal - 10-40 mcg per day in one or more admission to adults, 5-30 mcg for children from 3 months to 13 years

Side effects:

From the central nervous system: headache, dizziness, impaired consciousness, coma.

From the digestive system: intestinal colic, nausea, vomiting.

From the cardiovascular system: moderate increase in blood pressure (when used in high doses), arterial hypotension (with rapid intravenous administration), compensatory tachycardia,

From the respiratory system: rhinitis, edema of the nasal mucosa.

From the urinary system: oliguria.

From the side of the psyche: emotional lability (in children).

From the side of metabolism: water retention in the body, hyponatremia, hypoosmolality, weight gain.

From the endocrine system: algodismenorea.

From the side of the organ of vision: disturbances of lacrimation, conjunctivitis, hyperemia sclera.

Allergic reactions: skin rash.

Other: transient headache, local hyperemia, pain at the injection site, swelling, hot flashes.

Overdose:

There comes water intoxication, hypoosmolarity of the plasma, which leads to convulsions and other neurological / mental symptoms; headache, drowsiness, anuria, fluid retention.

Treatment: withdrawal of desmopressin, restriction of fluid intake, in severe cases - slow intravenous infusion of concentrated saline solutions simultaneously with furosemide.

Interaction:

Alcohol, heparin, demeclocycline, lithium, tetracycline, norepinephrine - Reduction of antidiuretic effect.

Ganglioblokatory - increased sensitivity to pressor effects of desmopressin.

Means that have the ability to increase the release of antidiuretic hormone (carbamazepine, clofibrate, urea, selective serotonin inhibitors, chlorpromazine, narcotic analgesics, lamotrigine, non-steroidal anti-inflammatory drugs, tricyclic antidepressants, fludrocortisone, chlorpropamide) - an increase in the antidiuretic effect.

Loperamide is an increase in the absorption of desmopressin.

Desmopressin enhances the action of hypertensive drugs (dopamine, norepinephrine, phenylephrine, epinephrine).

Cimetidine is the risk of bradycardia and asystole.

Indomethacin can increase the intensity (but not the duration) of desmopressin.

Simultaneous administration of non-steroidal anti-inflammatory drugs may increase the risk of side effects.

The combination of desmopressin with dimethicone may lead to a decrease in desmopressin absorption.

Special instructions:

In rhinitis appoint sublingually.To avoid water intoxication, you should limit the use of liquid.

When using desmopressin as a diagnostic tool, as well as when repeated doses are given intravenously, forced hydration (inside or parenteral) should not be performed, the patient should take as much fluid as needed to quench thirst.

The use of kidney concentration in children under 1 year of age should be performed only in a hospital setting.

Impact on the ability to drive vehicles and manage mechanisms

During the treatment period, there may be headache and dizziness, so care must be taken when performing activities that require concentration and vehicle management.

Instructions

Desmopressin (Desmopressinum)