Desmopressin

Desmopressin mimics the actions of endogenous ADH and acts as a selective agonist of V2 receptors expressed in the renal collecting duct to increase water re-absorption and reduce urine production. Desmopressin has been shown to be more potent than ADH in increasing plasma levels of factor VIII activity in patients with hemophilia and von Willebrand's disease Type I. Desmopressin demonstrates markedly diminished pressor activity.

• Central diabetes insipidus
• Primary nocturnal enuresis (bed-wetting)
• Nocturia (nocturnal polyuria)
• Hemophilia A and von Willebrand disease (Type I)

Desmopressin mimics the actions of endogenous ADH and acts as a selective agonist of V2 receptors expressed in the renal collecting duct to increase water re-absorption and reduce urine production. Desmopressin has been shown to be more potent than ADH in increasing plasma levels of factor VIII activity in patients with hemophilia and von Willebrand's disease Type I. Desmopressin demonstrates markedly diminished pressor activity.

Desmopressin binds to V2 receptors, increasing aquaporin insertion to enhance water reabsorption and reduce urine volume; it also increases factor VIII and von Willebrand factor to reduce bleeding episodes.

Adult - Diabetes Insipidus (PO): 0.05 mg every 12 hours; effective range 0.1-1.2 mg/day divided 8-12 hourly.
Adult - Diabetes Insipidus (Intranasal): 10-40 mcg/day (usually 20 mcg/day in 2 divided doses).
Adult - Nocturia (Sublingual): Women: 27.7 mcg/day; Men: 55.3 mcg/day, 1 hour before bedtime.
Child - Bed-wetting (>6 years): 0.2 mg PO at night (max 0.6 mg/day).
Hemophilia A/von Willebrand: 0.3 mcg/kg IV (30 min before procedure).

May be taken with or without food, but it is better to take it at a fixed time. Swallow the tablet whole, do not chew, crush or break. Sublingual tablets should be dissolved under the tongue without water.

If you miss a dose of Desmopressin, skip it and continue with your normal schedule. Do not double the dose.

Common: Headache, nausea, stomach pain.
Rare (high doses): Transient headache, nausea, flushing, mild abdominal cramps, decreased sodium levels (hyponatremia), water intoxication.

Fluid restriction is recommended (to prevent water intoxication and hyponatremia). Monitor sodium levels regularly. Do not use in patients with hyponatremia or history of hyponatremia. Caution in coronary artery insufficiency and hypertensive cardiovascular disease.

Hypersensitivity; moderate to severe renal impairment (CrCl <50 mL/min); hyponatremia or history; cardiac insufficiency with ongoing diuretic treatment.

NSAIDs, indomethacin, TCAs, chlorpromazine, carbamazepine, SSRIs, opiates, lamotrigine: May enhance antidiuretic effect.
Lithium, epinephrine (high doses), heparin, demeclocycline: May reduce antidiuretic effect.

It is unsafe to consume alcohol with Desmopressin (may increase risk of water intoxication).

Desmopressin is generally considered safe during pregnancy. Animal studies have shown low or no adverse effects to the developing baby; however, there are limited human studies.

Desmopressin is safe during breastfeeding. Human studies suggest that the drug does not pass into the breastmilk in a significant amount and is not harmful to the baby.

Dosage is established for children (>3 months). Safety in children under 3 months has not been established.

Elderly patients have increased risk of toxicity due to decreased renal function; caution is required.

Renal impairment: CrCl ≥50 mL/min: No adjustments necessary; <50 mL/min: Contraindicated.
Hepatic impairment: Limited information available. Please consult your doctor.

Overdose may lead to water intoxication and hyponatremia. Seek medical attention.

Store at temperature not exceeding 30°C in a dry place. Protect from light and moisture.

Desmopressin