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Desmopressin For Diabetes Insipidus

desmopressin for diabetes insipidus

Description

Because the cause of this form of diabetes insipidus is a lack of anti-diuretic hormone (ADH), treatment is usually with a synthetic hormone called desmopressin. You can take desmopressin as a nasal spray, as oral tablets or by injection. The synthetic hormone will eliminate the increase in urination.

Central diabetes insipidus (CDI) is the end result of a number of conditions that affect the hypothalamic-neurohypophyseal system. The known causes include germinoma/craniopharyngioma, Langerhans cell histiocytosis (LCH), local inflammatory, autoimmune or vascular diseases, trauma resulting from surgery or an accident, sarcoidosis, metastases and midline cerebral and cranial malformations. In rare cases, the underlying cause can be genetic defects in vasopressin synthesis that are inherited as autosomal dominant, autosomal recessive or X-linked recessive traits.

What is desmopressin tabs, and how does it work (mechanism of action)?

Desmopressin is a man-made analogue of vasopressin which is the body's natural anti-diuretic hormone released by the pituitary. It works by increasing water permeability in renal tubular cells, which decreases urine volume and increases urine concentration. In people with diabetes insipidus due to trauma or surgery in the pituitary region of the brain, it reduces frequent urination and thirst. The FDA approved desmopressin in February 1978.

Dosage

Adults and children 12 years of age and older: Initiate with 0.05 mg by mouth every 12 hours, may titrate up to 0.1 to 1.2 mg divided every 8 to 12 hours.

Children of 4 years to under 12 years of age: Initiate with 0.05 mg by mouth every 12 hours, may titrate up to 0.1 to 0.8 mg divided every 8 to 12 hours.

The intranasal dose for adults and children older than 12 years old is 10 to 40 mcg per day or divided and given in 2 or 3 doses (every 8 or 12 hours). The dose for children 3 months to 12 years is 5 to 30 mcg daily or divided and given every 12 hours.

The intravenous dose for adults and children older than 12 years of age is 2 to 4 mcg daily. Children 3 months to 12 years old should receive 0.1-1 mcg per day or divided and given every 12 hours.

What are the side effects of desmopressin tabs?

Side effects of Desmopressin are:

  • headache,
  • fatigue,
  • rhinitis,
  • abdominal pain, and
  • conjunctivitis
  • (pink eye).

Epidemiology

Diabetes insipidus is a rare disease with a nonunivocal reported prevalence of 1:25,000 [2]. Less than 10% of diabetes insipidus can be attributed to hereditary forms . In particular, X-linked NDI (OMIM 304800) represents 90% of cases of congenital NDI and occurs with a frequency of 4–8 per 1 million male live births; autosomal NDI (OMIM 125800) accounts for approximately 10% of the remaining cases . No gender difference has been reported for the other forms. While the prevalence of Wolfram syndrome has been reported as 1–9/1,000,000 (www.orpha.net), the frequency of autosomal dominant CDI is currently unknown.

Nephrogenic diabetes insipidus

If you have nephrogenic diabetes insipidus that's caused by taking a particular medication, such as lithium or tetracycline, your GP or endocrinologist may stop your treatment and suggest an alternative medication. However, don't stop taking it unless you've been advised to by a healthcare professional.

As nephrogenic diabetes insipidus is caused by your kidneys not responding to AVP, rather than a shortage of AVP, it  usually can't be treated with desmopressin. However, it's still important to drink plenty of water to avoid dehydration.

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