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Pharmacological action of DDAVP
Synthetic analogue of vasopressin. It has a pronounced antidiuretic effect. Compared to vasopressin, it has a lesser effect on the smooth muscles of blood vessels and internal organs. In diabetes insipidus, it enhances the reabsorption of water from the distal tubules of the kidneys, while increasing the relative osmotic density of urine. This helps to reduce the frequency of urination and eliminate the increased need for fluid.
Desmopressin activates blood coagulation factor VIII and increases the level of plasma plasmin activator. Being a polypeptide, it is destroyed by digestive enzymes of the gastrointestinal tract.
Desmopressin is destroyed in the gastrointestinal tract. After intranasal administration, absorption is 10-20%. Cmax of the active substance in plasma is achieved in 0.5-4 hours. It is metabolized in tissues. T1/2 in the initial phase - 8 minutes, in the final phase - 75 minutes.
Indications of the active substances of the drug Desmopressin
Diagnosis and treatment of diabetes insipidus; treatment of temporary polyuria and polydipsia after operations in the pituitary gland (only for intranasal use); bedwetting (both in the form of monotherapy and as part of complex therapy).
As a diagnostic tool for determining the concentration of the kidneys.
For intravenous administration: moderate and mild hemophilia A, von Willebrand disease.
Dosing regimen of DDAVP
Individual. For intranasal use in adults, the dose is 10-40 mcg / day in 1 or more doses, in children aged 3 months to 12 years - 5-30 mcg / day.
For subcutaneous, intramuscular or intravenous administration, the dose for adults is 1-4 mcg / day, for children - from 0.4 to 2 mcg / day.
Contraindications for use
Congenital or psychogenic polydipsia, anuria, fluid retention of various etiologies, plasma hypoosmolality, heart failure and other conditions that require diuretic therapy, hypersensitivity to desmopressin.
For intravenous administration: unstable angina pectoris, von Willebrand disease type IIB.
Application during pregnancy and lactation
There are no adequate and well-controlled studies of the safety of desmopressin during pregnancy and lactation. If it is necessary to use desmopressin in this category of patients, the expected benefits of therapy for the mother and the possible risk for the fetus or child should be weighed.
Application for impaired renal function
Desmopressin is prescribed with caution for impaired renal function.
Use in children
In order to avoid volume overload when prescribing desmopressin, special monitoring of the condition in children and adolescents is required. Application for the study of the concentration ability of the kidneys in children under the age of 1 year should be carried out only in a hospital setting.
Use in elderly patients
In order to avoid volume overload when prescribing desmopressin, special monitoring of the condition is necessary in the elderly.
In case of swelling of the nasal mucosa, severe rhinitis, the absorption of desmopressin may be impaired with intranasal administration. In such cases, sublingual administration is recommended.
In order to avoid volume overload when prescribing desmopressin, special monitoring of the condition is necessary in patients of the following groups: children and adolescents, the elderly, persons with impaired water and / or electrolyte balance, persons at risk of increased intracranial pressure. It is prescribed with caution for impaired renal function, cardiovascular diseases, fibrosis of the bladder.
When using desmopressin as a diagnostic agent, as well as with intravenous administration of repeated doses, forced hydration (by mouth or parenteral) should not be carried out, the patient should take as much fluid as is required to quench his thirst.
Application for the study of the concentration ability of the kidneys in children under the age of 1 year should be carried out only in a hospital setting.
Indomethacin can increase the intensity (but not the duration) of the action of desmopressin. Drugs that have the ability to increase the release of ADH (including tricyclic antidepressants, chlorpromazine, carbamazepine) can cause an additive antidiuretic effect, which increases the risk of fluid retention.
From the side of the central nervous system: headache, dizziness, impaired consciousness, coma.
From the digestive system: intestinal colic, nausea, vomiting.
From the side of the cardiovascular system: a moderate increase in blood pressure (when used in high doses), arterial hypotension (with rapid intravenous administration).
From the respiratory system: rhinitis, swelling of the nasal mucosa.
From the urinary system: oliguria.
From the side of metabolism: water retention in the body, hyponatremia, hypoosmolality, weight gain.
From the endocrine system: algodismenorrhea.
From the side of the organ of vision: disorders of lacrimation, conjunctivitis.
Allergic reactions: skin rash.