Desmopressin

Indications
 Oral
Cranial diabetes insipidus
Adult: Initially, 100 mcg tid adjusted according to response. Maintenance: 100-200 mcg tid, up to 100-1200 mcg daily.
Child: Initially, 100 mcg tid adjusted according to response. Maintenance: 100-200 mcg tid, up to 100-1200 mcg daily.
Oral
Primary nocturnal enuresis
Adult: 200-400 mcg at bedtime.
Child: ≥5 yr: 200-400 mcg at bedtime.
Nasal
Cranial diabetes insipidus
Adult: 10-40 mcg daily as a single or divided doses.
Child: 3 mth-12 yr: 5-30 mcg daily.
Nasal
Diagnosis of diabetes insipidus
Adult: 20 mcg as a single dose.
Child: 20 mcg as a single dose.
Nasal
Renal function testing
Adult: 40 mcg as a single dose.
Child: 1-15 yr: 20 mcg and infants: 10 mcg. To be given as a single dose.
Nasal
Primary nocturnal enuresis
Adult: 20-40 mcg at bedtime.
Child: ≥5 yr: 20-40 mcg at bedtime.
Nasal
Nocturia associated with multiple sclerosis
Adult: 10-20 mcg at bedtime.
Nasal
Type I Von Willebrand's disease
Adult: 300 mcg; <50 kg: 150 mcg. Should be given within 2 hr before the surgery.
Parenteral
Cranial diabetes insipidus
Adult: 1-4 mcg daily IM, SC or IV.
Child: 0.4 mcg IM, SC, or IV.
Parenteral
Diagnosis of diabetes insipidus
Adult: 2 mcg as a single dose via SC/IM.
Child: 2 mcg SC/IM.
Parenteral
Renal function testing
Adult: 2 mcg given as SC or IM inj.
Child: Infants: 0.4 mcg; children: 2 mcg. Dose to be given as SC or IM inj.
Intravenous
Type I Von Willebrand's disease
Adult: 0.3-0.4 mcg/kg by slow infusion over 15-30 min before surgery.
Intravenous
Testing of fibrinolytic response
Adult: 0.4 mcg/kg infused over 20 min.
Child: 0.4 mcg/kg infused over 20 min.
Contraindications
 Hypersensitivity. Impaired renal function (CrCl <50 ml/min). Decompensated cardiac failure with ongoing diuretic treatment.
Warnings / Precautions
 Not to be used in the treatment of Type IIb von Willebrand's disease and nephrogenic diabetes insipidus. Fluid intake restricted to a min and only to satisfy thirst for 8 hr after admin (particularly in the very young and the elderly). Nasal route avoided in patients with nasal mucosal diseases. Caution in CV diseases, oedema states, impairment, hypertension, elderly, cystic fibrosis, fluid and electrolyte imbalance, thrombotic disease; infants and young children. Inj not recommended for infants <3 mth for bleeding disorders. Pregnancy and lactation.
Adverse Reactions
 Nausea, transient headache; nasal congestion, rhinitis; flushing; mild abdominal cramps; epistaxis; sore throat, cough, stuffiness; allergic reactions, inj site pain, erythema, swelling, BP changes and thrombotic events in predisposed individuals.
Potentially Fatal: Water intoxication and dilutional hyponatraemia.
Drug Interactions
 Drugs that may potentiate antidiuretic effect of desmopressin: chlorpropamide, clofibrate, carbamazepine, fludrocortisone, urea, or TCAs. Drugs that may decrease antidiuretic effect of desmopressin: lithium, heparin, demeclocycline, noradrenaline, and alcohol. Caution when using with other vasopressors.
See Below for More desmopressin Drug Interactions
Lab Interactions
 Cross-reacts with some antisera raised against arginine vasopressin and oxytocin, but as these assays are rarely performed in clinical practice, it has little significance.
Mechanism of Actions
 Desmopressin increases the cellular permeability of the collecting ducts causing an increased water reabsorption, smooth muscle constriction. It also stimulates factor VIII and plasminogen activation activity in blood.
Absorption: Absorbed from the nasal mucosa (intranasal), absorbed in sufficient amounts from the GI tract to produce therapeutic effects at high doses (oral).
Metabolism: Largely destroyed in the GI tract.
Excretion: Elimination T1/2 (biphasic): 8 min (initial phase), 75 min (terminal phase).
Administration
 May be taken with or without food.
Storage Conditions
 Intravenous: Refrigerate at 2-8°C. Nasal: Refrigerate at 2-8°C. Oral: Store at 20-25°C. Parenteral: Refrigerate at 2-8°C.
ATC Classification
 H01BA02 - desmopressin ; Belongs to the class of vasopressin and analogues. Used in posterior pituitary lobe hormone preparations.
Storage
 Intravenous: Refrigerate at 2-8°C. Nasal: Refrigerate at 2-8°C. Oral: Store at 20-25°C. Parenteral: Refrigerate at 2-8°C.
Available As
  • Desmopressin 0.1 mg
  • Desmopressin 0.2 mg
  • Desmopressin 1 mcg
  • Desmopressin 10 mcg

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