Uropres

The intranasal drug Uropres belongs to the group of vasopressin analogues – hormonal drugs with systemic action.

Indications Uropresa

Uropres is prescribed to reduce the daily urine output:

• in diabetes insipidus of central origin;
• with increased diuresis due to trauma, in the event of a transient deficiency or insufficiency of antidiuretic hormone after removal of the pituitary gland;
• after surgery in the area of the pituitary gland;
• after a traumatic brain injury.

Uropres is also used as an express diagnostic to determine the concentration properties of the kidneys, as well as to differentiate diabetes insipidus.

Release form

Uropres is an intranasal drops based on desmopressin. The drops are a transparent liquid without a specific color or odor. When thoroughly mixed, visible foam is formed on the surface, which settles within half an hour.

Uropres is packaged in 2.5 or 5 ml bottles and packed in a cardboard box.

Pharmacodynamics

Uropres is made on the basis of desmopressin, a structural analogue of the natural hormonal substance L-arginine-vasopressin.

Uropres increases the permeability of the epithelium of the distal sections of the renal tubules and accelerates the reverse absorption of water. At the same time, the amount of excreted urine decreases, its osmolarity increases, but the osmolarity indices in the blood serum decrease. As a result of the above processes, approaches to urination become less frequent, especially at night.

The effect of reducing urine outflow after the administration of Uropres in an amount of 10-20 mcg can last from eight to twelve hours.

Pharmacokinetics

The bioavailability of Uropres after administration into the nasal cavity is approximately 3-5%. Noticeable concentrations of the active ingredient in the blood serum are detected after 15-30 minutes. The concentration limit is observed after 60 minutes, but this indicator may depend on the dosage of the drug used.

The distribution volume is estimated at 0.2-0.3 liters/kg.

The active ingredient Uropres does not cross the blood-brain barrier.

The half-life after administration of Uropres into the nasal cavity can range from two to three hours.

A small amount of the active ingredient undergoes hepatic metabolism.

Dosing and administration

Uropres can only be used by intranasal application. Before applying drops to the mucous membrane, it is necessary to clear the nasal passages.

One drop of Uropres contains 5 mcg of active ingredient.

• For patients with diabetes insipidus, with polyuria after injuries, as well as with pathological thirst of central origin, the amount of Uropres is selected individually. The optimal dose is considered to be from 10 to 20 mcg up to 2 times a day. In childhood (over 12 months), a single dosage is 10 mcg up to 2 times a day. If signs of fluid retention in tissues occur during the treatment period, Uropres is temporarily canceled until the dosage is fully adjusted.
• To carry out express diagnostics, the following dosages are used:
  • for adult patients – 40 mcg;
  • for children in the first year of life – 10 mcg;
  • children over 12 months – 20 mcg.

Express diagnostics are prescribed to differentiate diabetes insipidus and polyuria syndrome, or to assess the renal concentration function, which may be impaired due to infectious pathologies of the urinary system. In addition, this diagnostic method can be used in the early stages of tubulointerstitial pathology - for example, when affected by lithium-based medications, painkillers, chemotherapy agents or immunosuppressants.

Express diagnostics are most often performed in the morning. It is important to limit the patient's drinking regimen for twelve hours after the procedure. For children under five years of age and for patients with high blood pressure or coronary diseases, fluid intake is reduced by 50%.

Before the express diagnostic procedure, the osmotic concentration of the urine fluid is assessed. After the introduction of Uropres, two urine samples are collected (for example, after 2 and 4 hours). The "first" urine, which is collected during the first hour, is poured out. The osmotic concentration is determined in the remaining two samples.

Low values, no growth or slight growth of values indicate a disordered concentration function of the kidneys. If the osmotic concentration increases significantly and the amount of urine decreases, this may mean that the increase in daily diuresis is related to diabetes insipidus of central origin.

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Use Uropresa during pregnancy

Clinical testing of Uropres, which was conducted in pregnant and lactating patients, did not reveal any adverse effects for the woman or the baby. Thus, Uropres is approved for use during pregnancy as a replacement therapy drug for antidiuretic hormone deficiency.

Only a small amount of Uropres is found in breast milk. This amount is not enough to affect the amount of urine output in a nursing infant.

Contraindications

The use of Uropres should be avoided:

• if the patient's body is prone to an allergic response;
• in case of initial or psychogenic pathological thirst, in case of “alcoholic polydipsia”;
• in severe stages of von Willebrand disease (2b), with reduced activity of factor eight to 5%, as well as with existing antibodies to factor eight;
• in case of insufficient cardiac activity, or other conditions that should be accompanied by increased urine output;
• in case of moderate or significant renal impairment (with creatinine clearance less than 50 ml per minute);
• in case of syndrome of inappropriate production of antidiuretic hormone;
• in case of hyponatremia.

Side effects Uropresa

Excessive fluid intake can cause hyperhydration, which manifests itself in the following symptoms:

• weight gain;
• decrease in sodium levels in the blood;
• convulsions;
• disorders of consciousness.

The above picture is often observed in infants under 1 year of age, or in old age.

Other side effects when using Uropres may include:

• increased blood pressure, hot flashes, angina attacks;
• headaches, cerebral edema, disturbances of consciousness, hyponatremic seizures;
• difficulty breathing through the nose, runny nose, bleeding from the nasal mucosa, thirst;
• dyspepsia;
• hyperhidrosis;
• allergic reactions (rash, bronchospasm, itching, fever, anaphylactic shock).

In isolated cases, emotional disturbances were recorded in pediatric patients.

After adjusting the dosage of Uropres, side effects usually disappear: the exception is allergic reactions.

Overdose

Signs of an overdose of Uropres may include:

• weight gain associated with edema;
• headaches;
• nausea;
• slight increase in blood pressure;
• increased heart rate;
• tides;
• convulsions.

Often, signs of overdose are diagnosed in children, which is associated with an incorrect determination of the dose of Uropres.

If an overdose is suspected, the doctor must reconsider the correctness of the prescription of Uropres. In case of cerebral edema, the patient must be hospitalized in the intensive care unit. Immediate treatment is also used in the presence of seizures in pediatric patients.

There is no specific treatment for overdose of Uropres. Furosemide is prescribed if indicated.

Interactions with other drugs

The combination of Uropres and Oxytocin may result in an increase in the antidiuretic effect and a decrease in uterine perfusion.

The effect of Uropres can be enhanced by medications such as Clofibrate, Indomethacin or Carbamazepine.

The effect of Uropres can be weakened by drugs based on lithium salts, as well as Glibenclamide.

The combination of Uropres with Chlorpromazine, tricyclic antidepressants, selective serotonin reuptake inhibitors, non-steroidal anti-inflammatory drugs may lead to increased effectiveness of Uropres, which in turn may cause fluid retention in tissues.

Any combination of Uropres with the above drugs should be monitored for changes in blood pressure, diuresis and the amount of sodium in the blood.

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Storage conditions

Store Uropres in a dark place, out of reach of children. Optimum temperature limits for preserving the medicine are from +2°C to +8°C.

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Shelf life

Uropres can be stored in packaging for up to 2 years at the appropriate temperature.

After opening the bottle, the shelf life is reduced to fifty days. After the expiration date, Uropres must be thrown away.