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Desmopressin
McCarty TS, Shah AD.
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Objectives:
Indications
Desmopressin (1-deamino-8-D-arginine
vasopressin) is a synthetic analog of vasopressin,
aka antidiuretic hormone created in 1977 used in
the treatment of a wide variety of medical
conditions to include nocturnal polyuria,
hemophilia A, diabetes insipidus, Willebrand
disease, uremic bleeding, as well as many off label
uses such as an adjunct with hypertonic saline to
prevent rapid sodium correction, intracranial
hemorrhage associated with varying antiplatelet
agents, and trauma resuscitation with active
hemorrhage.[1][2][3]
Mechanism of Action
Desmopressin is a selective vasopressin V2
receptor agonist present throughout the collecting
ducts and distal convoluted tubules of the kidneys.
[1][18] The V2 receptor is a Gs-protein coupled
receptor, which, when activated, results in a
signaling cascade of adenyl-cyclase, prompting an
increase in cyclic adenosine monophosphate
(cAMP) in the renal tubule cells, ultimately
resulting in increased water permeability. This
activity leads to a decrease in urine volume and an
increase in urine osmolality.
Administration
Desmopressin can be administered intravenously,
as a subcutaneous injection, as an intranasal spray,
and, most recently, as a dissolvable sublingual
strip. The tablet form has been discontinued in
many countries in favor of the intranasal and
sublingual forms due to the latter's superior
bioavailability.[7] The administration of
intravenous and subcutaneous dose forms of the
drug are predominantly in the hospital setting.
Dosing for both is 0.3 micrograms/kg. Peak blood
concentration after intravenous administration
occurs within 30 to 60 minutes and after
subcutaneous administration within 60 to
90 minutes.[1]
Adverse E!ects
The major adverse effect of desmopressin for which
to monitor is hyponatremia. As desmopressin
increases the urine concentration, it can also lead to
systemic hyponatremia with physiology similar to
the syndrome of inappropriate antidiuretic
hormone.[22] In certain instances, the
hyponatremia caused by this drug can precipitate
seizures. The minor adverse effects that may affect
individual patients are headaches, tachycardia, and
facial flushing. There have been certain instances
where patients receiving desmopressin have
suffered from strokes or myocardial infarctions.
However, these cases were rare and did not
establish with certainty that desmopressin exerted a
direct influence in these cases.[1]
Contraindications
Hyponatremia is an absolute contraindication to the
administration of desmopressin, except for
symptomatic hyponatremia warranting aggressive
management with the potential for osmotic
demyelinating syndrome. Desmopressin acts
primarily in the nephron; this drug is
contraindicated in patients with renal impairment.
[22] Also, renal function decreases with age;
therefore, care is necessary when prescribing this
drug in the older population. This drug should also
be avoided in younger patients, especially those
under the age of 2, as it is difficult to restrict water
and fluids in such patients.[1] Additionally, this
drug is ineffective in patients suffering from type 3
von Willebrand disease; therefore, these patients
should not receive the drug.[1] Finally, patients
suffering from thrombocytopenic purpura should
not receive desmopressin, as it can precipitate a
thrombotic event.[1] Lastly, desmopressin is
contraindicated in patients with known
hypersensitivity to desmopressin acetate.
Monitoring
Desmopressin is generally well-tolerated in most
patients. There are a few instances where patients
require monitoring for adverse effects of the drug.
Patients receiving desmopressin need monitoring
for the occurrence of hyponatremia.[23] Symptoms
of hyponatremia include nausea, confusion, or
altered mental status.[24] As patients age, they
should also be continually monitored for declining
renal function, as the therapeutic index and
clearance of the drug will change according to the
renal function.
Toxicity
There is no known antidote to an overdose of
desmopressin. The most worrisome complication to
result from an overdose is water intoxication. This
condition would result in a delayed loss of
consciousness and seizures in some
instances. Patients require immediate admission to
the intensive care unit to be monitored and have
electrolyte correction.[25]
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References
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Publication Details
Authors
A"liations
1
Naval Medical Center San Diego
2
Warren Alpert Medical School, Brown University
Publication History
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Publisher
NLM Citation