The P-I-E-N-O Parkinsn's List Drug Database
desmopressin / DDAVPTM
ANTIDIURETIC / Antienuresis:
MODERATE RISK
Description: Desmopressin is a synthetically prepared structural analog of vasopressin (antidiuretic hormone, or ADH), the endogenous posterior pituitary hormone that acts to maintain serum osmolality within a physiologically acceptable range. Desmopressin is more potent and much longer acting than vasopressin, and it is used to prevent or control polyuria, polydipsia, and dehydration in patients with central diabetes insipidus. It is not effective for nephrogenic diabetes insipidus. The drug is also used to control polydipsia and polyuria that occur following pituitary surgery or trauma, and to manage primary nocturnal enuresis. Desmopressin is also indicated for the management of bleeding episodes in patients with hemophilia A or Type I von Willebrand's disease. Desmopressin was approved by the FDA in 1978.
Desmopressin is commercially available as an injection or as a nasal solution, which is preferred over the parenteral preparation because of its long duration of action and lower incidence of adverse effects. Nasal preparations of desmopressin have about one-tenth the antidiuretic effect of an intravenously administered dose, but both forms have been used to control polydipsia, polyuria, and dehydration secondary to a deficiency of endogenous vasopressin or to pituitary trauma.
Mechanism of Action: Vasopressin increases the resorption of water at the level of the renal collecting duct, thereby reducing urinary flow and increasing urine osmolality. When administered to patients with neurohypophysial (e.g., central) diabetes insipidus, desmopressin exerts antidiuretic effects similar to those of vasopressin. Serum concentrations of potassium, sodium, and creatinine do not change following the administration of desmopressin, and urinary excretion of potassium and sodium also remains the same. In contrast to vasopressin, desmopressin does not induce the release of adrenocorticotropic hormone or increase plasma cortisol concentrations, and desmopressin has slight structural variations that reduce its vasopressive activity and contractile action on visceral smooth muscle. Desmopressin increases plasma factor VIII and plasminogen activator to a greater extent than equivalent weights of vasopressin.
Desmopressin is administered intranasally for the management of primary nocturnal enuresis. It is administered parenterally to control bleeding episodes or to maintain hemostasis in patients with hemophilia A or Type I von Willebrand's disease who have a plasma factor VIII activity of not less than 5%. Desmopressin will not be effective in patients with hemophilia A who have plasma factor VIII activity that is 5% or less or in patients with hemophilia B or factor VIII antibodies. Patients with mild to moderate Type I von Willebrand's disease usually will respond favorably to desmopressin therapy, but the drug will be ineffective in patients with severe Type I von Willebrand's disease. Desmopressin is contraindicated for use in patients with type IIB or platelet-type von Willebrand's disease because it can precipitate platelet aggregation.
Pharmacokinetics: Approximately 10-20% of an intranasally administered dose of desmopressin is absorbed across the nasal mucosa. Antidiuretic effects usually occur within 15-60 minutes, with peak effects evident 1-5 hours after administration. The effects of the drug last for about 5-21 hours, followed by an abrupt cessation of activity that occurs over a 60to 90-minute period. Plasma factor VIII activity increases 15-30 minutes after intravenous administration, with peak activity occurring in 1.5-3 hours. This increase is dose-dependent, with an IV dosage of 0.4 ęg/kg producing a 300-400% maximum increase. The distribution of the drug is unknown, and it is not clear whether desmopressin crosses the placenta. Desmopressin is found in breast milk. The terminal half-life of a 2-3 ęg intravenous dose of desmopressin is 0.4-4 hours. It is not known if the drug is metabolized; however, in contrast to vasopressin, desmopressin does not appear to be degraded by the peptidase enzymes responsible for metabolizing endogenous vasopressin during the last trimester of pregnancy.
CONTRAINDICATIONS/PRECAUTIONS: The vasoactive effects associated with the administration of desmopressin are minimal. Nonetheless, the drug should be used with caution in patients with hypertension or coronary artery disease. In addition, desmopressin should be used with caution in patients with a history of thromboembolic disease because the drug rarely can precipitate such events.
Desmopressin is contraindicated for use in patients with von Willebrand's disease type IIB because it can precipitate platelet aggregation.
There are no adequate studies of the effects of this drug on the human fetus, but animal reproduction studies have shown no adverse fetal effects. Desmopressin is classified as pregnancy category B.
DRUG INTERACTIONS: The antidiuretic response to desmopressin may be reduced in patients receiving lithium, high doses of epinephrine, demeclocycline, heparin, or ethanol concomitantly. Caution should be used when coadministering these agents.
The antidiuretic effect of desmopressin can be enhanced by the concomitant administration of urea, fludrocortisone, clofibrate, or chlorpropamide. Dosages may require adjustment. In addition, the following drugs have been associated with drug-induced SIADH: carbamazepine, cyclophosphamide, cisplatin, vincristine, tricyclic antidepressants, phenothiazines, general anesthetics, opiate agonists, and barbiturates. The administration of carbamazepine prior to administration of desmopressin may act to reduce the duration of action of desmopressin.
ADVERSE REACTIONS: Adverse effects associated with intranasal administration of desmopressin are rare, but hypertension can occur with high doses of intranasally administered desmopressin. Adverse effects usually are reversible with dosage reduction and rarely may require discontinuance of therapy.
Excessive doses of desmopressin can cause hyponatremia, seizures, and/or coma. High doses of IV desmopressin have been reported to cause facial flushing, hypotension, and sinus tachycardia.
Thrombosis has been reported following the parenteral administration of desmopressin, so the drug should be used with caution in patients with a history of thrombotic events.
Other adverse effects associated with the parenteral administration of desmopressin include abdominal pain, headache, and nausea/vomiting. These effects usually can be alleviated with a reduction in dosage.
The risk of overhydration can be increased in patients receiving the drug to maintain hemostasis because these patients are not deficient in endogenous vasopressin and can experience water intoxication following the administration of desmopressin. These patients should limit fluid intake. Severe water retention can be corrected by adminstration of a diuretic agent.
PATIENT INFORMATION:
What does desmopressin injection do?
Desmopressin (DDAVPTM ) is a synthetic (laboratory-made) form of the hormone vasopressin (antidiuretic hormone, or ADH) produced by the pituitary gland. Vasopressin helps to keep a regular balance of salts in the blood and to control the amount and frequency of urination. Without vasopressin too much water is lost in the urine. Desmopressin helps to prevent or control frequent urination, excessive thirst, and dehydration associated with diabetes insipidus or with certain brain injuries. Desmopressin also can be used in the treatment of bedwetting, hemophilia, or von Willebrand's disease. Desmopressin cannot be given by mouth because it is destroyed in the stomach. Generic desmopressin injections are not yet available.
What should my doctor, dentist, and pharmacist know before I receive desmopressin?
They need to know if you have any of these conditions:
How should I use this medicine?
Desmopressin is for injection into a vein, or under the skin. If you have been instructed to give yourself desmopressin injections, make sure that you understand how to prepare and inject the dose. Use exactly as directed. Do not exceed the prescribed dose, and do not use more or less often than prescribed.
Special precautions for use in children:
This medicine is not for infants under 3 months old, and is only for certain conditions in older children.
What if I miss a dose?
If you use two or more doses per day, use the missed dose as soon as you remember. If it is nearly time for the next dose, skip the missed dose and resume your regular schedule with the next dose. Do not use double doses.
If you use one dose per day, use the missed dose as soon as you remember on the day the dose was due. If you do not remember until the next day, skip the missed dose and resume your regular schedule with the next dose. Do not use double doses.
What other medicines can interact with desmopressin?
Tell your doctor or pharmacist: about all other medicines you are taking including non-prescription medicines; if you are a frequent user of drinks with caffeine or alcohol; if you smoke; or if you use illegal drugs. These can affect the way your medicine works. Check before stopping or starting any of your medicines.
What side effects might I notice from receiving desmopressin?
Serious side effects with desmopressin include:
Call your doctor as soon as you can if you get any of these side effects.
Minor side effects with desmopressin include:
Let your doctor know about these side effects if they do not go away or if they annoy you.
What do I need to watch for while I receive desmopressin?
Visit your doctor for regular checks on your progress.
Desmopressin can prevent the loss of water. Only drink enough fluid to satisfy your thirst. Too much water in the body dilutes normal body fluids and can cause confusion, drowsiness, or lethargy, which may lead to seizures or coma. The risk of too much water in the body is greater in young children and the elderly. Ask your doctor for advice about your fluid intake.
Where can I keep my medicine?
Keep out of the reach of children.
Store in a refrigerator between 2 and 8C (36 and 46F); do not freeze. Throw away any unused medicine after the expiration dose.
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