Desmopressin other

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. 

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... 

Finally, it is interesting to note the close agreement between the diffusion coefficient of Desmopressin obtained by NMR on the one hand, with that obtained from the release experiments on the other. This agreement gives further support to... 

Cryoprecipitate may also be used for patients with factor VIII deficiency and von Willebrand disease if desmopressin is not indicated and a pathogen-inactivated, recombinant, or plasma-derived product is not available. The concentration of factor VIII and von Willebrand factor in cryoprecipitate is not as great as that found in the concentrated plasma fractions. Moreover, cryoprecipitate is not treated in any manner to decrease the risk of viral exposure. For infusion, the frozen cryoprecipitate unit is thawed and dissolved in a small volume of sterile citrate-saline solution and pooled with other units. Rh-negative women with potential for childbearing should receive only Rh-negative cryoprecipitate because of possible contamination of the product with Rh-positive blood cells. 

Three other cases of myocardial infarction in the absence of desmopressin have been reported in patients with hemolytic-uremic syndrome, who already have an increased risk of thrombosis. 

There are isolated reports of thromboembolic complications in recipients of desmopressin most occurred in patients with pre-existing vascular disease. However, in nine trials of the hemostatic efficacy of desmopressin in reducing blood and transfusion requirements in 763 patients, there were no significant differences between the frequencies of thromboembolism in subjects treated with desmopressin and controls (33). An analysis of 31 clinical trials of desmopressin in patients undergoing cardiac, vascular, orthopedic, or other major surgery showed that desmopressin did not increase the incidence of thrombosis (34). 

In 103 children with cranial diabetes insipidus, 3 children who started or had an increase in dose of lamotrigine needed a larger dose of desmopressin, suggesting an effect on the renal tubule or on drug clearance (76). Lamotrigine also increased desmopressin dosage requirements in two other children with cranial diabetes insipidus (78). 

Mannucci PM, Vicente V, Vianello L, Cattaneo M, Alberca I, Coccato MP, Faioni E, Mari D. Controlled trial of desmopressin in liver cirrhosis and other conditions associated with a prolonged bleeding time. Blood 1986 67(4) 1148-53. 

One report described adverse reactions in two pregnant women with von Willebrand disease (59). One went into premature labor after a single dose (attributed to the oxytocic effect of desmopressin) and the other had severe hyponatremia associated with seizures after repeated administration of desmopressin to cover a cesarean section. 

Comparison of the nasal route with other routes has been made in some instances. Desmopressin (l-desamino-8-D-arginine vasopressin) administered as a 20 pg dose elicits a response equivalent to approximately 2 pg administered by i.v. injection. Also, a greater dose of vims is required to obtain an equivalent response to a nasal vaccine than when administered by other routes. 

Some hematologists find desmopressin beneficial in treating patients with type 2B von Willebrand disease, while others feel it may exacerbate thrombocytopenia. 

B. Desmopressin is a vasopressin analog. Symptoms are consistent with D1 arising from surgical trauma to the pituitary or hypothalamus and impairment of vasopressin release. The other possibihties would not be alleviated by desmopressin. 

Lundin, P., Bojrup, M., Ljusberg-Wahren, H., Westrom, B.R. and Lundin, S. (1997) Enhancing effects of monohexanoin and two other medium-chain glyceride vehicles on intestinal absorption of desmopressin (Ddavp). /. Pharm. Exp. Ther., 282, 585-590. 

Only two antidiuretic peptides are available for clinical use in the United States (1) Vasopressin (synthetic 8-l-arginine vasopressin Pitressin) is available as a sterile aqueous solution it may be administered subcutaneously, intramuscularly, or intranasally. (2) Desmopressin acetate (synthetic l-deamino-8-D-arginine vasopressin DDAVP, others) is available as a sterile aqueous solution packaged for intravenous or subcutaneous injection, in a nasal solution for intranasal administration with either a nasal spray pump or rhinal tube delivery system, and in tablets for oral administration. The therapeutic uses of vasopressin and its congeners can be divided into two main categories according to the type of vasopressin receptor involved. 

A. Orthostatic hypotension. The most important is to limit use of vasoactive substances. If non-pharmacologic measures are not mough then fludrocortisone should be tried starting with a dose of 0.1 mg at bedtime and increased to 0.4 mg/day [38], Side effects are oedema and recumbent hypertension. Other compounds that have been tested with positive results include Erythropoietin, Octreotide, desmopressin and midodrine. 

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