Desmopressin

Desmopressin has a vasopressor effect.

[1], [2], [3], [4], [5], [6], [7]

Indications of the desmopressin

Applicable for the following activities:

• therapy / diagnosis of diabetes insipidus or the diagnosis of concentrating renal capacity;
• transient polyuria;
• intranasal use after performing surgical procedures on the pituitary site;
• with combined treatment or monotherapy for the elimination of urinary incontinence of a primary nature (spray);
• IV injection in the treatment of classical hemophilia, as well as Willebrand-Diane disease (except subtype 2b);
• nocturia.

[8], [9]

Release form

The release is made in the form of a spray for intranasal use, in a flacon equipped with a dispenser dispenser, a capacity of 5 ml (enough for 50 servings). Inside the box there is one such bottle.

Also produced in the form of tablets, 28, and 30 or 90 pieces inside the pack.

[10], [11]

Pharmacodynamics

The active element of the drug activates the V2-terminations of vasopressin, which are located inside the epithelial tissues of the convoluted tubules, and also within the ascending knee of the Henle loop. As a result, water is reabsorbed into the vessels of the circulatory system, and along with this, stimulation of the 8th factor of blood uptake occurs.

The antihypertensive effect of the drug is observed with injections in / m and / in the method, as well as with intranasal and oral administration. Desmopressin has a low level of toxicity, and does not have mutagenic or teratogenic effects.

[12], [13], [14], [15], [16],

Pharmacokinetics

The half-life of the artificial hormone is 75 minutes. But in this case the drug in fairly high values can be observed inside the body for 8-20 hours after use. It was revealed that the signs of polyuria pass after 2-3 treatments. In this case, intravenous injections are more effective than intranasal administration.

In people with Willebrand's disease, as well as hemophilia with a single injection of 0.4 μg / kg of substance, an increase of 3-4 times the 8th factor of blood turnover is observed. The medication begins to act after 30 minutes after its application and reaches peak values after 1.5-2 hours.

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

The drug passes the metabolism inside the liver tissue. The disulfide bridge is cleaved with the enzyme transhydrogenase enzyme.

Excretion of unchanged substance or inactive metabolic products occurs with urine.

[17], [18], [19], [20],

Dosing and administration

Tablets should be consumed inside, after a few hours after eating (with the simultaneous use of them may weaken the absorption of drugs, which will lead to a decrease in its effectiveness). The sizes of portions and duration of therapy are selected by the doctor.

People with diabetes of a non-sugar type at the initial stage are required to take inward 0.1 mg of substance 1-3 times / day. After this, it is necessary to individually select a portion, taking into account the effect of the tablets, and their tolerability by the patient. On average, the drug dosage is 0.1-0.2 mg, with administration 1-3 times per day.

The size of the maximum allowable oral dose of drugs per day is 1.2 mg.

At night incontinence of a primary nature, 0.2 mg of substance is often ingested orally at night. If the effect is insufficient, the portion is doubled - up to 0.4 mg. During the treatment should limit the intake of liquid in the second half of the day. On average, continuous therapy lasts 90 days. In view of the clinical picture, the doctor can prolong the course (often, before the prolongation of treatment, the drug is canceled for 7 days, and then, taking into account the received clinical information after the drug cancellation, decide whether the patient is required to continue the course).

Adults, with polyuria night-type, often require ingestion of 0.1 mg of medication at night. In the absence of a therapeutic result, it is possible to increase the dose in half 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 the 1st month of drug use, treatment should be canceled.

Intranasal spray is used in portions of 10-40 μg / day, which are divided into several separate uses. Children aged at least 3 months and a maximum of 12 years should adjust the daily dose, which is between 5-30 μg.

Dosages of desmopressin for IV, SC, as well as IV injections are 1-4 μg / day (adults). Children for the day are allowed to inject 0.4-2 μg of the drug.

If there is no result after the first week of treatment, the daily dose should be adjusted. It is sometimes necessary to select a suitable treatment regimen - within a few weeks.

[25], [26], [27], [28], [29], [30]

Use of the desmopressin during pregnancy

Use Desmopressin in lactation or pregnancy is allowed exclusively under the constant supervision of the treating doctor.

Contraindications

The main contraindications:

• polydipsia of psychogenic or innate character;
• the presence of anuria;
• plasma hypo-osmolality;
• fluid retention within the body;
• the presence of heart failure with the need to use diuretics;
• an allergic response to the medication.

It is forbidden to administer the medication intravenously in case of von Willebrand-Dian disease subtype 2b, and in addition, with unstable angina

[21]

Side effects of the desmopressin

The use of medication can cause the development of such side effects:

• headaches, coma, dizziness, loss of consciousness or a sense of confusion;
• the development of a runny nose or hypo-osmolality, the appearance of edema on the nasal mucosa and weight gain;
• increase or decrease in blood pressure (the latter - in the case of rapid IV injection);
• the development of hyponatremia or oliguria, the appearance of swelling, and in addition, the retention of fluid within the body;
• stomach pain, vomiting, colic in the intestines and nausea;
• rash on the skin surface and other symptoms of allergies, algodismenorea, and also hot flashes;
• problems with lacrimation and conjunctivitis of allergic origin;
• pain at the injection site.

[22], [23], [24]

Overdose

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

In these cases, it is required to introduce intravenously an iso- or hypertonic solution of sodium chloride, and also to appoint a patient to take a diuretic (furosemide).

[31]

Interactions with other drugs

Combination with dopamine, especially at high dosages, can potentiate pressor effects.

Indomethacin affects the intensity of Desmopressin medication.

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

Carefully you need to combine the medicine with medications that increase the severity of the release of the antidiuretic hormone: such as carbamazepine with chlorpromazine, phenylephrine with tricyclics and epinephrine. A similar combination can cause potentiation of the vasopressor effect of drugs.

[32], [33]

Storage conditions

Desmopressin should be kept in a dark place, closed from penetration of children. Temperature values are within the limits of 15-25 ° C.

Shelf life

Desmopressin in tablets can be used for 30 months from the date of manufacture of drugs. Shelf life of the spray is 2 years.

[34], [35], [36], [37], [38]

Application for children

The size of the daily portion for children less than 12 years old must be adjusted.

Infants up to 1 year of intoxication with substance can lead to the development of seizures - in connection with the irritant effect of the drug on the NA.

[39], [40], [41], [42], [43], [44]

Analogues

Analogues of the substance are Vazomirin, Minirin and Emosint with Presayneks, and in addition, Adiuretin, desmopressin acetate, Nurem with Nativa, Apo Desmopressin and Adiuretin SD.

[45], [46], [47]

Reviews

Desmopressin receives positive reviews in 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. In this case, the commentary speaks of the good tolerability of the drug.

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