Desmopressin

Oral
Cranial diabetes insipidus
Adult: Initially, 100 mcg tid, adjust according to response. Maintenance: 100-200 mcg tid up to 100-1,200 mcg daily.
Child: Same as adult dose.

Oral
Primary nocturnal enuresis
Adult: Initially, 200 mcg at bedtime, may titrate up to 600 mcg to achieve desired response.
Child: ≥6 yr Initially, 200 mcg at bedtime, may titrate up to 600 mcg to achieve desired response.

Sublingual
Cranial diabetes insipidus
Adult: Initially, 60 mcg tid. Maintenance: 60-120 mcg tid up to 720 mcg daily.
Child: Same as adult dose.

Nasal
Cranial diabetes insipidus
Adult: 10-20 mcg once daily or bid.
Child: 5-20 mcg daily. Infants may require lower dose.

Nasal
Diagnosis of diabetes insipidus
Adult: 20 mcg as a single dose.
Child: Same as adult dose.

Nasal
Renal function testing
Adult: 40 mcg as a single dose.
Child: ≤1 yr 10 mcg; >1-15 yr 20 mcg. Both given as a single dose.

Nasal
Nocturia associated with multiple sclerosis
Adult: 10-20 mcg at bedtime.

Nasal
Type I Von Willebrand's disease
Adult: 300 mcg; <50 kg: 150 mcg. Should be given 0.5-2 hr before surgery.

Parenteral
Cranial diabetes insipidus
Adult: 1-4 mcg once daily via IV, IM or SC inj.
Child: 0.4 mcg daily via IV, IM, SC inj.

Parenteral
Diagnosis of diabetes insipidus
Adult: 2 mcg via IM or SC inj.
Child: Same as adult dose.

Parenteral
Renal function testing
Adult: 2 mcg via IM or SC inj.
Child: Same as adult dose.

Intravenous
Type I Von Willebrand's disease
Adult: 0.4 mcg/kg by slow infusion over 15-30 min before surgery. Further dose may be given at 12-hr interval.
Child: Same as adult dose.
Reconstitution: IV infusion: Dilute in 10 mL or 50 mL of NaCl 0.9% inj.

Intravenous
Testing of fibrinolytic response
Adult: 0.4 mcg/kg infusion over 20 min.
Child: Same as adult dose.
Reconstitution: IV infusion: Dilute in 10 mL or 50 mL of NaCl 0.9% inj.

Parenteral
Headache following lumbar puncture
Adult: 4 mcg via IM or SC inj, may be repeated after 24 hr if needed. May also be given as prophylaxis.

May be taken with or without food.

Cardiac insufficiency w/ ongoing diuretic treatment. Patient w/ habitual and psychogenic polydipsia, hyponatraemia or history of hyponatraemia. Moderate to severe renal impairment (CrCl <50 mL/min).

Patient w/ CV disease or cystic fibrosis, coronary artery insufficiency, at risk for increased intracranial pressure, predisposed to thrombus formation. Elderly and childn. Pregnancy and lactation. Monitoring Parameters Monitor BP and pulse during IV infusion.

Headache, nausea, stomach pain, allergic skin reaction and more severe general allergic reactions, cerebral or coronary thrombosis. Local irritation, congestion and epistaxis. Pain and swelling at the inj site.
Potentially Fatal: Anaphylaxis.

Symptoms: Prolonged duration of action w/ an increased risk of water retention and/or hyponatraemia. Management: Symptomatic treatment. Fluid restriction.

May enhance antidiuretic effect w/ NSAIDs (e.g. ibuprofen), indometacin, TCAs, chlorpromazine, carbamazepine, SSRIs, opiates, lamotrigine. May reduce antidiuretic effect w/ lithium, epinephrine (large dose), heparin, demeclocycline.

May reduce antidiuretic effect w/ alcohol.

Desmopressin increases cyclic adenosine monophosphate (cAMP) in renal tubular cells which increases water permeability resulting in reduced urine volume and enhanced urine osmolality. It also stimulates factor VII and plasminogen activator activity in the blood, but w/ minimal pressor activity.
Onset: Antidiuretic: Approx 60 min (oral); 15-30 min (intranasal).
Duration: Approx 6-14 hr.
Absorption: Absorbed minimally from the GI tract; absorbed from the nasal mucosa. Bioavailability: 0.08-0.16% (oral); 10-20% (intranasal). Time to peak plasma concentration: 0.9 hr (oral); 1.5 hr (intranasal).
Excretion: Mainly via urine. Elimination half-life: 2-4 hr.

Intravenous: Soln for inj: Store between 2-8°C. Protect from light. Nasal: Store between 20-25°C. Protect from light. Oral: Store between 20-25°C. Protect from light. Parenteral: Soln for inj: Store between 2-8°C. Protect from light. Sublingual: Store between 20-25°C. Protect from light.

Antidiuretics

H01BA02 - desmopressin ; Belongs to the class of vasopressin and analogues. Used in posterior pituitary lobe hormone preparations.