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Mechanism of Action
Desmopressin, an analogue of vasopressin (ADH), reduces the nocturnal urine output and therefore the frequency of enuresis. Desmopressin does not have an influence on the smooth muscles tonus or blood pressure (such as vasopressin).
- Enuresis: after failure of convervative non-pharmacological treatment
- Central diabetes insipidus or other antidiuretic hormone deficiency
Pharmacokinetics of Desmopressin
- Desmopressin has a very low bioavailability when administered orally (under 1%) with considerable individual variations.
- The half-life time of desmopressin after oral administration is 2 to 3 hours.
Side Effects of Desmopressin
- Water retention with hyponatremia: in particular, if the drinking amount is increased
- Warning signs are headache, nausea/vomiting, or weight gain.
- Increased risk of cerebral edema with seizures
- Headache, stomach pain, abdominal cramps
Contraindications of Desmopressin
- Patients with vomiting and diarrhea, fever, the flu, or severe cold.
- Hypersensitivity to desmopressin
- Polydipsia: psychological causes or due to alcoholism
Pharmacological Interactions of Desmopressin
Do not prescribe desmopressin together with drugs that stimulate ADH secretion, cause water retention or with an increased risk of hyponatremia: antidepressants, selective serotonin reuptake inhibitors, chlorpromazine, carbamazepine or NSAIDs. When given orally, the treatment with loperamide triples the desmopressin concentration.
Dosage of Desmopressin
Treatment of Enuresis
First trial with desmopressin is done with 200 micrograms p.o. 0-0-1 for 2 weeks. Only if the treatment effect is insufficient, the dosage is increased to 400 micrograms p.o. 0-0-1 for 2 weeks. If the treatment is successful, the treatment with desmopressin is continued. It is important to observe the drinking rules to avoid the above mentioned side effects of desmopressin.
Treatment of Diabetes Insipidus
The initial dosage of desmopressin is 100 micrograms three times daily in adults and children. The dosage is increased depending on the clinical effects (diuresis, body weight, sodium concentration...), the maintenance dosage ranges usually between 300 and 600 micrograms per day.
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ReferencesSchultz-Lampel und Thüroff 2000 SCHULTZ-LAMPEL, D. ; THÜROFF, J. W.: Enuresis und kindliche Harninkontinenz.
In: THÜROFF, JW (Hrsg.) ; SCHULTE-WISSERMANN, H (Hrsg.): Kinderurologie in Klinik und Praxis.
Stuttgart New York : Thieme, 2000, S. 265–275
Deutsche Version: Desmopressin