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| Trade names | DDAVP (deamino D-arginine vasopressin), Minirin, others |
| AHFS/Drugs.com | Monograph |
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| Routes of administration | IV,IM,SC, intranasal, by mouth, under the tongue |
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| Pharmacokinetic data | |
| Bioavailability | Variable; 0.08–0.16% (by mouth) |
| Protein binding | 50% |
| Eliminationhalf-life | 1.5–2.5 hours |
| Excretion | Kidney |
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| CompTox Dashboard(EPA) | |
| ECHA InfoCard | 100.037.009 |
| Chemical and physical data | |
| Formula | C46H64N14O12S2 |
| Molar mass | 1069.22 g·mol−1 |
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Desmopressin, sold under the trade nameDDAVP among others, is a medication used to treatdiabetes insipidus,bedwetting,hemophilia A,von Willebrand disease, andhigh blood urea levels.[1] In hemophilia A and von Willebrand disease, it should only be used for mild to moderate cases.[1] It may be givenin the nose,by injection into a vein,by mouth, orunder the tongue.[1]
Common side effects includeheadaches,diarrhea, andlow blood sodium.[1] The low blood sodium that results may causeseizures.[1] It should not be used in people with significantkidney problems or low blood sodium.[1] It appears to be safe to use duringpregnancy.[1] It is asynthetic analogue ofvasopressin, thehormone that plays roles in the control of the body's osmotic balance, blood pressure regulation, kidney function,[2] and reduction ofurine production.[1]
Desmopressin was approved for medical use in the United States in 1978.[1] It is on theWorld Health Organization's List of Essential Medicines.[3] It is available as ageneric medication.[1]
Desmopressin is used to treatnocturnal enuresis (bedwetting). It is usually prescribed in the form of desmopressin acetate, by mouth. Children taking DDAVP have 2.2 fewer wet nights per week and are 4.5 times more likely to sleep without disruption compared with placebo.[4][5]
In 2017, the FDA approved Desmopressin has some benefit for adults who have problems withnocturia (having a need to wake up at night for urination).[6][7]
Desmopressin (DDAVP) is usually the first line treatment for mild to moderate type 1von Willebrand disease.[1] It is not recommended in severe disease or in those with abnormalfactor VIII.[1] Usefulness in type 2A, 2M, or 2N von Willebrand disease is variable.[1] Generally not recommended in 2B and type 3 von Willebrand disease.[1]
Desmopressin is only recommended in mild hemophilia A.[1] It may be used both for bleeding due to trauma or to try to prevent bleeding due to surgery.[1] It is not effective in the treatment of hemophilia B (factor IX deficiency) or severe hemophilia A.[1] May also be used inuremia induced bleeding.[1]
Desmopressin is used in the treatment ofcentral diabetes insipidus (DI) as a replacement for endogenousantidiuretic hormone (ADH) that is in insufficient quantity due to decreased or non-existent secretion or production of ADH by the posterior pituitary or hypothalamus, respectively. It is also used in thediagnostic workup for diabetes insipidus, in order to distinguish central fromDI due to the kidneys. Desmopressin is not effective at treating nephrogenic DI, thus a positive response is generally indicative of central DI.
US drug regulators added warning to the nasal sprays after two people died and fifty-nine other people had seizures. This occurred due tohyponatremia, a deficit of the body's sodium levels, and the nasal spray is no longer approved for use in children in the United States.[8] However, US drug regulators have said that desmopressin tablets can still be considered safe for treatment of nocturnal enuresis in children as long as the person is otherwise healthy.
Patients must stop taking desmopressin if they develop severe vomiting and diarrhea, fever, the flu, or severe cold. Patients should also be very cautious about taking desmopressin during hot weather conditions or following strenuous exercise, as these conditions can place stress on the body's electrolyte and water balance.
A body needs to maintain a balance of water andsodium. If sodium levels become too low (hyponatremia) – either as a result of increased water take-up or reduced salt levels – a person may haveseizures and, in extreme cases, may die.[9]
Desmopressin works by limiting the amount of water that is eliminated in the urine; that is, it is anantidiuretic. It works at the level of therenal collecting duct by binding toV2 receptors, which signal for the translocation ofaquaporin channels via cytosolic vesicles to the apical membrane of the collecting duct. The presence of these aquaporin channels in the distal nephron causes increasing water reabsorption from the urine, which becomes passively re-distributed from the nephron to systemic circulation by way of basolateral membrane channels.[10] Desmopressin also stimulates release ofvon Willebrand factor fromendothelial cells by acting on the V2 receptor. It also increases endogenous levels of factor VIII, making it useful in the treatment of hemophilia A.[11]
Desmopressin is degraded more slowly thanrecombinant vasopressin, and requires less frequent administration. In addition, it has little effect onblood pressure, while vasopressin may causearterial hypertension.[12] Vasopressin stimulates the release ofACTH, which indirectly increases responsiveness of alpha-1 receptor in blood vessel smooth muscle, increasing vessel tone and blood pressure.[2] Several studies have shown that Desmopressin does not stimulate ACTH release (except inCushing's Disease),[13][14][15] and therefore does not directly raise blood pressure, however, one study showed that it stimulates ACTH release in over 50% of healthy subjects.[16] Additionally, desmopressin is able to enhance ACTH and cortisol release in normal subjects following oCRH administration, but not in patients withanorexia nervosa.[15]
Desmopressin (1-deamino-8-D-arginine vasopressin) is a synthetic form of the normal human hormonearginine vasopressin (the antidiuretic hormone, or ADH), a peptide containing nine amino acids.
Compared to vasopressin, desmopressin's first amino acid has beendeaminated, and thearginine at the eighth position is in thedextro rather than thelevo form (seestereochemistry).
