Desmopressin agent

The two primary agents used to treat enuresis are desmopressin and imipramine (Table 50-7). Desmopressin is the drug of choice in pediatric enuresis. Anticholinergics have a limited role (Table 50-7). Other agents have been studied with inconclusive results.28... 

At higher doses desmopressin also has significant hematological effects and can significantly boost concentrations of factor VIII and von Willebrand factor (VWF) in the blood. Desmopressin is therefore a valuable agent for the treatment of mild and moderate hemophilia A (congenital or acquired) and type 1 von Willebrand disease, in which the VWF protein structure is normal but... 

Most of the reported thromboembolic complications occurred in elderly patients and desmopressin should not be used in patients with documented arterial disease or even in elderly patients, in whom some degree of latent arterial disease may be assumed to be present (34). Concomitant use of antifibrinolytic agents, such as tra-nexamic acid, should also be avoided. 

Our observation that CMC lacked the ability to increase the systemic activity of desmopressin is consistent with the findings of Morimoto et al. (13), who reported that 1% CMC failed to enhance intranasal absorption of insulin, whereas, another bioadhesive agent, polyacrylic acid gel, effectively promoted insulin absorption. As the mechanism by which bioadhesives such as polyacrylic acid gel and carboxypolymethylene promote intranasal peptide absorption remains unclear, it is not possible to explain the demonstrated lack of similar activity by CMC. 

DIABETES INSIPIDUS TREATMENT involves the administration of drugs to counteract the under-production of antidiuretic hormone (ADH vasopressin) by the pituitary gland, which is a characteristic of diabetes insipidus. ADH itself (arginine vasopressin or lysine vasopressin) can be used, as can the analogues desmopressin and terlipressin. These are all (V subtype) VASOPRESSIN RECEPTOR AGONISTS. These agents are discussed... 

Vasopressin (Pitressin) may be administered either subcutaneously or intramuscularly. It has a duration of action of 2 to 8 hours. Vasopressin tannate (pitressin tannate) is a suspension and should be injected intramuscularly only. It has a duration of action of 2 to 3 days. Desmopressin acetate (DDAVP) is used topically. Lypressin is administered as an intranasal spray. All these agents may be used in the treatment of central diabetes insipidus (vasopressin sensitive) (see also Figure 102). 

Vasopressin has little, if any, place in the long-term therapy of D1 because of its short duration of action and Vj receptor-mediated side effects. Vasopressin can be used as an alternative to desmopressin in the initial diagnostic evaluation of patients with suspected D1 and to control polyuria in patients with D1 who recently have undergone surgery or experienced head trauma. Under these circumstances, polyuria may be transient, and long-acting agents may produce water intoxication. 

Ozier Y, Bellamy L. Pharmacological agents antifibrinolytics and desmopressin. Best Pract Res Clin Anaesthesiol 2010 24(1) 107-19. 

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