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Desmopressin Mechanism Of Action

desmopressin mechanism of action

Description

Desmopressin, sold under the trade name DDAVP among others, is a medication used to treat diabetes insipidus, bedwetting, hemophilia A, von Willebrand disease, and high blood urea levels. In hemophilia A and von Willebrand disease, it should only be used for mild to moderate cases. It may be given in the nose, by injection into a vein, by mouth, or under the tongue.

Common side effects include headaches, diarrhea, and low blood sodium. The low blood sodium that results may cause seizures. It should not be used in people with significant kidney problems or low blood sodium. It appears to be safe to use during pregnancy. It is a synthetic version of vasopressin, the hormone that reduces urine production.

Mechanism of action

Upon binding of desmopressin to V2 receptors in the basolateral membrane of the cells of the distal tubule and collecting ducts of the nephron, adenylyl cyclase is stimulated. The resulting intracellular cascades in the collecting duct lead to increased rate of insertion of water channels, called aquaporins, into the lumenal membrane and enhanced the permeability of the membrane to water.

Treatments and investigations

The subjects were allocated to either the desmopressin or mefenamic acid group according to a schedule provided by an envelope system developed using computer analysis.

Each patient in the desmopressin group received a single daily dose of high‐concentration intranasal desmopressin (HCIN‐DDAVP; Minirin; Ferring s.p.a, Milan, Italy) administered as a morning 300 µg dose (one intranasal spray in each nostril) for the first 5 days of menstruation, irrespective of the duration of the menstrual period.

Patients in the mefenamic acid group were instructed to take one 500 mg tablet every 8 h for 5 days from the onset of menstrual bleeding, irrespective of the duration of the menstrual period.

Drug interactions

Although the pressor activity of DDAVP (desmopressin acetate tablets) is very low compared to its antidiuretic activity, large doses of DDAVP (desmopressin acetate tablets) Tablets should be used with other pressor agents only with careful patient monitoring. The concomitant administration of drugs that may increase the risk of water intoxication with hyponatremia, (e.g. tricyclic antidepressants, selective serotonin re-uptake inhibitors, chlorpromazine, opiate analgesics, NSAIDs, lamotrigine and carbamazepine) should be performed with caution.

Warnings

Very rare cases of hyponatremia have been reported from world-wide postmarketing experience in patients treated with DDAVP (desmopressin acetate). DDAVP (desmopressin acetate tablets) is a potent antidiuretic which, when administered, may lead to water intoxication and/or hyponatremia. Unless properly diagnosed and treated hyponatremia can be fatal. Therefore, fluid restriction is recommended and should be discussed with the patient and/or guardian. Careful medical supervision is required.

When DDAVP (desmopressin acetate tablets) Tablets are administered, in particular in pediatric and geriatric patients, fluid intake should be adjusted downward to decrease the potential occurrence of water intoxication and hyponatremia. (See PRECAUTIONS, Pediatric Use and Geriatric Use.) All patients receiving DDAVP (desmopressin acetate tablets) therapy should be observed for the following signs of symptoms associated with hyponatremia: headache, nausea/vomiting, decreased serum sodium, weight gain, restlessness, fatigue, lethargy, disorientation, depressed reflexes, loss of appetite, irritability, muscle weakness, muscle spasms or cramps and abnormal mental status such as hallucinations, decreased consciousness and confusion. Severe symptoms may include one or a combination of the following: seizure, coma and/or respiratory arrest.

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