Desmopressin
Mechanism :
Desmopressin acetate is a synthetic analogue of the natural hormone arginine vasopressin. Desmopressin acetate has been shown to be more potent than arginine vasopressin in increasing plasma levels of Factor VIII activity in patients with hemophilia and von Willebrand’s disease Type I.
Enhances reabsorption of water in kidneys.
Possibly causes smooth muscle contraction with resultant vasoconstriction.
Indication :
- Hemophilia A
- Von Willebrand’s Disease (Type I)
- Diabetes Insipidus
- Primary Nocturnal Enuresis
Contraindications :
Contraindicated in individuals with known hypersensitivity to desmopressin acetate or to any of the components.
Renal Disease & Cardiac insufficiency.
Dosing :
Diabetes Insipidus:
3 months-12 years:
Intranasal: 5-30 mcg/day as a single dose or in 2 divided doses.
Oral: 0.05 mg twice a day. Dose range is 0.1 to 0.8 mg daily.
>12 years of age:
Intranasal: 10 to 40 mcg/day divided into 1 to 3 doses.
Oral: 0.05 mg twice daily. Dose range is 0.1 to 1.2 mg divided into 2 or 3 doses.
IV:
1 to 2 mcg twice a day.
Subcutaneously:
1 to 2 mcg twice a day.
Hemophilia A and Von Willebrand’s disease (Type 1):
3 months-12 years: IV 0.3 mcg/kg by slow infusion over 15-30 minutes beginning 30 minutes before procedure. May repeat dose if needed.
>12 year of age: IV 0.3 mcg/kg once slowly over 15-30 minutes.
Intranasal:
>50 kg: 150 mcg in each nostril.
<50 kg: 300 mcg in each nostril.
Primary Nocturnal Enuresis:
>6 years: 0.2 to 0.6 mg orally once daily before bedtime.
Adverse Effect :
Transient headache, nausea, mild abdominal cramps, vulval pain, facial flushing, transient headache, nausea, nasal congestion, rhinitis and flushing, sore throat. With nasal spray: somnolence, dizziness, itchy or light-sensitive eyes, insomnia, chills, warm feeling, pain, chest pain, palpitations, tachycardia, dyspepsia, edema, vomiting, hyponatremia, water intoxication, agitation and balanitis.
Interaction :
Tricyclic Antidepressant, Carbamazepine, Chlorpromazine and Indomethacin: Potentiated. Although the pressor activity of desmopressin acetate is very low, its use with other pressor agents should be done only with careful patient monitoring.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in normal renal function |
| HD | Unlikely to be dialysed. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Unlikely to be dialysed. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended.