Desmopressin

Indications

Desmopressin is used for: Diabetes Insipidus, Primary nocturnal enuresis

Adult Dose

Nasal Cranial diabetes insipidus Adult: 10-40 mcg daily as a single or divided doses. Diagnosis of diabetes insipidus Adult: 20 mcg as a single dose. Renal function testing Adult: 40 mcg as a single dose. Primary nocturnal enuresis Adult: 20-40 mcg at bedtime. Nocturia associated with multiple sclerosis Adult: 10-20 mcg at bedtime. Type I Von Willebrand's disease Adult: 300 mcg; <50 kg: 150 mcg. Should be given within 2 hr before the surgery.

Child Dose

Nasal Cranial diabetes insipidus Child: 3 mth-12 yr: 5-30 mcg daily. Diagnosis of diabetes insipidus Child: 20 mcg as a single dose. Renal function testing Child: 1-15 yr: 20 mcg and infants: 10 mcg. To be given as a single dose. Primary nocturnal enuresis Child: >5 yr: 20-40 mcg at bedtime.

Renal Dose

Administration

Contra Indications

Hypersensitivity. Impaired renal function (CrCl <50 ml/min). De compensated cardiac failure with ongoing diuretic treatment.

Precautions

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.

Pregnancy-Lactation

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.

Adverse Effects

Side effects of Desmopressin : Nausea, transient headache; nasal congestion, rhinitis; flushing; mild abdominal cramps; epistaxis; sore throat, cough, stuffiness; allergic reactions, BP changes and thrombotic events in predisposed individuals. Potentially Fatal: Water intoxication and dilutional hyponatraemia.

Mechanism of Action

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.