Desmopressin intranasal

Lethagen S, Ragnarson Tennvall G. Self-treatment with desmopressin intranasal spray in patients with bleeding disorders effect on bleeding symptoms and socioeconomic factors. Ann Hematol 1993 66(5) 257-60. 

Piroxicam betacyclodextrin Plasminogen activator injection (actilyse), desmopressine intranasal Podophyllotoxin Polysaccharide pneumococcal vaccine... 

Another Vj receptor-mediated application is the use of desmopressin for primary nocturnal enuresis. Bedtime administration of desmopressin intranasal spray or tablets provides a high response rate that is sustained with long-term use, that is safe, and that accelerates the cure rate. Desmopressin also relieves post-lumbar puncture headache, probably by causing water retention and thereby facditating rapid fluid equilibration in the CNS. 

Desmopressin may be given orally, intranasally, SC, or IV. The oral dose must be determined for each individual patient and adjusted according to the patient s response to therapy. When the drug is administered nasally, a nasal tube is used for administration. The nasal tube delivery system comes with a flexible calibrated plastic tube called a rhinyle. The solution is drawn into the rhinyle. One end is inserted into the nostril and the patient (if condition allows) blows the other end to deposit solution deep into the nasal cavity. A nasal spray pump may also be used. Most adults require 0.2 mL daily in two divided doses to control diabetes insipidus. The drug may also be administered via the SC route or direct IV injection. 

Educating the Patient and Family If lypressin or desmopressin is to be used in the form of a nasal spray or is to be instilled intranasally usingthe nasal tube delivery system, the nurse demonstrates the technique of instillation (see Fhtient and Family Teaching Checklist Self-Adnrinistering Nasal Vasopressin). The nurse includes illustrated patient instructions with the drug and reviews them with the patient. If possible, the nurse lias the patient demonstrate the technique of administration. The nurse should discuss the need to take the drug only as directed by the primary health care provider. The patient should not increase the dosage (ie, the number or frequency of sprays) unless advised to do so by the primary health care provider. 

Desmopressin (DDAVP) increases the release of factor VIII (von Willebrand factor) from endothelial tissue in the vessel wall. Bleeding time is promptly reduced, within 1 hour of administration, and is sustained for 4 to 8 hours.42 Doses used for uremic bleeding are 0.3 to 0.4 mcg/kg intravenously over 20 to 30 minutes, 0.3 mcg/kg subcutaneously, or 2 to 3 mcg/kg intranasally. Repeated doses can cause tachyphylaxis by... 

Primary therapy is based on disease severity and type of hemorrhage.7 Most patients with mild to moderate disease and a minor bleeding episode can be treated with l-desamino-8-D-arginine vasopressin [desmopressin acetate (DDAVP)], a synthetic analog of the antidiuretic hormone vasopressin. DDAVP causes release of von Willebrand factor (vWF) and factor VIII from endogenous storage sites. This formulation increases plasma factor VIII levels by three- to fivefold within 30 minutes. The recommended dose is 0.3 mcg/kg intravenously (in 50 mL normal saline infused over 15 to 30 minutes) or subcutaneously or 300 meg intranasally via concentrated nasal spray every 12 hours. Peak effect with intranasal administration occurs 60 to 90 minutes after administration, which is somewhat later than with intravenous administration. Desmopressin infusion may be administered daily for up to 2 to 3 days. Tachyphylaxis, an attenuated response with repeated administration, may occur after several doses.8... 

Patients with central DI are usually treated with intranasal desmopressin, beginning with 10 mcg/day and titrating as needed, usually to 10 meg twice daily. 

Desmopressin (the synthetic analog of vasopressin) acts by increasing water retention and urine concentration in the distal tubules of the kidney. This drug is administered intranasally (20-40 pg or one to two sprays) using a unit-dose, spray pump delivery system. The duration of action is 10 to 12 hours. The medication is expensive. 

Desmopressin acetate increases the factor VIII activity of patients with mild hemophilia A or von Willebrand disease. It can be used in preparation for minor surgery such as tooth extraction without any requirement for infusion of clotting factors if the patient has a documented adequate response. High-dose intranasal desmopressin (see Chapter 17) is available and has been shown to be efficacious and well tolerated by patients. 

Desmopressin can be administered intravenously, subcutaneously, intranasally, or orally. The half-life of circulating desmopressin is 1.5-2.5 hours. Nasal desmopressin is available as a unit dose spray that delivers 0.1 mL per spray it is also available with a calibrated nasal tube that can be used to deliver a more precise dose. Nasal bioavailability of desmopressin is 3-4%, whereas oral bioavailability is less than 1%. 

Vasopressin and desmopressin are treatments of choice for pituitary diabetes insipidus. The dosage of desmopressin is 10-40 meg (0.1-0.4 mL) in two to three divided doses as a nasal spray or, as an oral tablet, 0.1-0.2 mg two to three times daily. The dosage by injection is 1-4 meg (0.25-1 mL) every 12-24 hours as needed for polyuria, polydipsia, or hypernatremia. Bedtime desmopressin therapy, by intranasal or oral administration, ameliorates nocturnal enuresis by decreasing nocturnal urine production. Vasopressin infusion is effective in some cases of esophageal variceal bleeding and colonic diverticular bleeding. 

Desmopressin Activates vasopressin V2 receptors much more than Vi Acts in the kidney to decrease the excretion of water acts on extrarenal V2 receptors Pituitary diabetes insipidus hemophilia A and von Willebrand disease Oral, IV, SC, or intranasal Toxicity Gastrointestinal disturbances, headache, hyponatremia, allergic... 

Facial flushing occurred in two of 25 children with either hemophilia or von Willebrand disease given high-dose intranasal desmopressin (150 micrograms) in a singledose open study (19). 

There was a slight but significant increase in calcium excretion in 15 girls and 17 boys, median age 9.8 years, who received desmopressin 30 micrograms by intranasal spray for 4 weeks, withdrawn for 2 weeks, and then continued for at least 3 further weeks (47). This is unlikely to be significant in the short term and whether it would have any significance in the long term is uncertain. 

A 37-year-old woman with primary enuresis continued her customary daily fluid intake (2 liters) when she started intranasal desmopressin 30 micrograms at night. Within 2 days she became severely hyponatre-mic, with loss of consciousness, generalized seizures, and cerebral edema. 

Fluid balance and plasma electrolytes should be monitored to prevent this complication, particularly if repeated doses are required. Children seem to be particularly vulnerable to this complication (55). In a longterm, open study of 245 Swedish children given intranasal desmopressin 20-40 micrograms at night for enuresis, five had an asymptomatic fall in plasma sodium (36). Mild hyponatremia, which did not cause symptoms, was found in five of 399 children in an open, multicenter trial (56). 

Gill JC, Ottum M, Schwartz B. Evaluation of high concentration intranasal and intravenous desmopressin in pediatric patients with mild hemophilia A or mild-to-moderate type 1 von Willebrand disease. J Pediatr 2002 140(5) 595-9. 

Odeh M, Oliven A. Coma and seizures due to severe hyponatremia and water intoxication in an adult with intranasal desmopressin therapy for nocturnal enuresis. J Clin Pharmacol 2001 41(5) 582-4. 

Drugs that are routinely administered intranasally include peptides such as vasopressin and its analog desmopressin, luteinizing hormone-releasing hormone, buserelin, leuprolide, nafarelin,... 

For nocturnal enuresis, desmopressin, 10-20 Mg (0.1-0.2 mL) intranasally at bedtime, is used. 

Results from the intranasal trials with histamine and desmopressin have been previously reported ( 12) but will be summarized here for purposes of comparison to the CMC findings. Desmopressin alone, in these trials, significantly reduced the NBF response compared to vehicle administration (Table I). The administration of 20 meg histamine immediately prior to desmopressin restored the NBF response to levels significantly greater than desmopressin alone (Table I). CMC combined with desmopressin had no effect on the NBF response compared to desmopressin alone (Table I). We have previously demonstrated a linear dose-response relationship of intranasal histamine on NBF response over a dosing range of 20 to 500 meg (42). In that study, a single intranasal histamine dose of 20 meg increased NBF response by two fold compared to vehicle. 

CMC did not enhance the ability of desmopressin to concentrate the urine, as measured by urine osmolality or volume response (Table 11). There was also no evidence of any acute effect of the combination of CMC and desmopressin on urinary electrolyte or creatinine concentration (Table 11). The intranasal administration of histamine immediately prior to desmopressin increased the antidiuretic response to desmopressin. Compared to vehicle treatment, urine flow rate response was depressed for a longer duration in response to histamine and desmopressin than after desmopressin alone (Table II). Also it was observed that only histamine and desmopressin in combination, significantly lowered (p < 0.05) cumulative 24 hour urine volume compared to vehicle. As a measure of acute antidiuretic activity, dosing with histamine immediately prior to... 

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. 

The increase in desmopressin activity observed in association with an increase in NBF due to coadministered histamine suggests that peptide absorption through the nasal mucosal membrane is in part, blood flow limited. Previous studies (15,fr3) have indicated that the duration of activity of desmopressin is directly related to the intranasal dose administered and resultant peak plasma desmopressin levels. These findings support our hypothesis that histamine enhanced desmopressin activity by increasing its mucosal absorption. 

In summary, CMC had no effect on NBF response and failed to promote the activity of desmopressin after intranasal coadministration. Intranasal desmopression produced a fall in NBF response, compared to vehicle, whereas histamine coadministration reversed this effect. The combination of histamine and desmopression demonstrated increased pharmacodynamic... 

Intranasal Desmopressin is administered intranasally in the treatment of diabetes insipidus salmon calcitonin, a peptide hormone used in the treatment of of osteoporosis, is available as a nasal spray. The abused drug, cocaine, is generally taken by sniffing. 

Because of the pressor properties of vasopressin, this compound has been modified to desmopressin [dez moe PRESS in] (1-desamino-8-D-arginine vasopressin). This analog is now preferred for diabetes insipidus and nocturnal enuresis because it is largely free of pressor effects and is longer-acting than vasopressin. Desmopressin is conveniently administered intranasally. However, local irritation may occur. 

There are two types of disturbances in vasopressin secretion. In central diabetes insipidus, vasopressin secretion is reduced it can be treated by giving vasopressin or desmopressin, which has a longer half-life, by mouth or intranasally. In nephrogenic diabetes insipidus, the plasma vasopressin concentration may be normal but the kidney fails to respond. The latter type of diabetes insipidus does not respond to vasopressin therapy but, paradoxically, can be managed by giving a thiazide diuretic, for example chlortalidone, at a maintenance dose of 50 mg daily. 

Desmopressin (DDAVP) (see p. 712) 0.3-0.4 micrograms/kg body weight i.v. (also available in a concentrated intranasal form) increases factor VIII and von Willebrand factor levels by 3-5 times baseline in mild to moderate haemophilia A its use may render transfusion unnecessary after minor procedures such as dental extraction. It is cdso effective in mild to moderate t5q)e 1 von Willebrand s disease for which DDAVP offers nontransfusional treatment. Tachyphylaxis occurs with repeated dosage but stores are repleted after an interval of 2-4 days. Patients with severe deficiency of either factor and patients with any form of haemophilia B do not respond to DDAVP. Adverse effects include flushing, headache, tachycardia, mild h)q)ertension and hyponatraemia. 

Law, S.L. Huang, K.J. Chou, H.Y. Preparation of desmopressin-containing liposomes for intranasal delivery. J. 

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