Desmopressin (DMP)
Desmopressin (DMP)
Desmopressin (DMP) is a synthetic analog of the natural hormone vasopressin (antidiuretic hormone, ADH) used primarily to reduce urine production and control symptoms related to water balance disorders and certain bleeding disorders.
Indications
- Central Diabetes Insipidus: Desmopressin replaces deficient vasopressin to reduce excessive urine output and thirst caused by impaired ADH secretion.
- Primary Nocturnal Enuresis (Bed-wetting): Used in children aged 6 years and older to reduce nighttime urine production.
- Nocturia due to Nocturnal Polyuria: In adults who wake at least twice per night to urinate, desmopressin decreases urine volume at night.
- Post-Head Injury or Brain Surgery Polyuria: Controls excessive urine output and thirst following trauma or surgery affecting the pituitary.
- Bleeding Disorders: Used in mild hemophilia A and type 1 von Willebrand disease to increase plasma levels of factor VIII and von Willebrand factor, helping to maintain hemostasis during minor surgeries or bleeding episodes.
Mechanism of Action
Desmopressin acts as a selective agonist of V2 receptors in the renal collecting ducts, promoting water reabsorption and reducing urine volume. It mimics endogenous ADH but has enhanced antidiuretic potency and a longer half-life with fewer vasopressor (blood pressure-raising) effects. In bleeding disorders, desmopressin stimulates release of stored factor VIII and von Willebrand factor from endothelial cells, improving clotting.
Dosage and Administration
- Available in oral tablets, sublingual tablets, intranasal sprays, and injectable forms.
- For central diabetes insipidus, dosing is individualized, often starting at 0.05 mg orally twice daily and titrated to effect.
- For bed-wetting, typically taken once at bedtime.
- For bleeding disorders, administered parenterally before minor procedures.
- Fluid intake should be carefully managed to avoid water intoxication and hyponatremia.
Side Effects
- Common: Headache, nausea, facial flushing, dizziness, mild increase in blood pressure or pulse, urinary retention.
- Serious: Hyponatremia (low blood sodium) leading to symptoms like muscle weakness, cramps, headache, nausea, vomiting, seizures.
- Fluid restriction is advised for 24 hours after dosing to minimize risk of water retention.
Precautions
- Monitor sodium levels to prevent hyponatremia.
- Avoid use in nephrogenic diabetes insipidus or in patients with hyponatremia.
- Use cautiously in patients with cardiovascular disease due to potential fluid overload.
- Not indicated for secondary nocturia in adults or nephrogenic diabetes insipidus.
Summary Table
| Aspect | Details |
|---|---|
| Drug Class | Synthetic vasopressin analog (antidiuretic hormone analog) |
| Indications | Central diabetes insipidus, nocturnal enuresis, nocturia, bleeding disorders (mild hemophilia A, von Willebrand disease) |
| Mechanism of Action | V2 receptor agonist → increased water reabsorption in kidneys; stimulates clotting factor release |
| Forms | Oral tablets, sublingual tablets, intranasal spray, injection |
| Common Side Effects | Headache, nausea, flushing, dizziness, urinary retention |
| Serious Side Effects | Hyponatremia, seizures |
| Fluid Management | Restrict fluids for 24 hours post-dose to prevent water intoxication |
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References
- MedlinePlus: Desmopressin Drug Information [https://medlineplus.gov/druginfo/meds/a608010.html][1]
- DrugBank: Desmopressin [https://go.drugbank.com/drugs/DB00035][2]
- NCBI Bookshelf: Desmopressin – StatPearls [https://www.ncbi.nlm.nih.gov/books/NBK554582/][3]
- Cleveland Clinic: Desmopressin Tablets [https://my.clevelandclinic.org/health/drugs/19345-desmopressin-tablets][4]
- WebMD: Desmopressin Oral [https://www.webmd.com/drugs/2/drug-12128/desmopressin-oral/details][5]
- FDA Label: Desmopressin Acetate Tablets [https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021795s006lbl.pdf][6]
- UNC School of Medicine: Desmopressin (DDAVP) Education [https://www.med.unc.edu/htcenter/resources/medication-resources/desmopressin-ddavp-education/][7]
- Drugs.com: Desmopressin Uses and Side Effects [https://www.drugs.com/mtm/desmopressin.html][8]
Desmopressin is a versatile medication essential for managing disorders of water balance and certain bleeding conditions, with careful dosing and monitoring required to ensure safety and efficacy.
