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desmopressin

Desmopressin

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.

More potent and longer acting than vasopressin.

In patients with central diabetes insipidus DI, desmopressin is the drug of choice.

A synthetic analogue of antidiuretic hormone (ADH), desmopressin is available in subcutaneous, IV, intranasal, and oral preparations.

Generally, it can be administered 2-3 times per day. Patients may require hospitalization to establish fluid needs. Frequent electrolyte monitoring is recommended during the initial phase of treatment.

Alternatives to desmopressin as pharmacologic therapy for DI include synthetic vasopressin and the nonhormonal agents chlorpropamide, carbamazepine, clofibrate (no longer on the US market), thiazides, and nonsteroidal anti-inflammatory drugs (NSAIDs). Because of side effects, carbamazepine is rarely used, being employed only when all other measures prove unsatisfactory. NSAIDs (eg, indomethacin) may be used in nephrogenic DI, but only when no better options exist. In central DI, the primary problem is a hormone deficiency; therefore, physiologic replacement with desmopressin is usually effective. Use a nonhormonal drug for central DI if response is incomplete or desmopressin is too expensive.

Indications

Desmopressin (DDAVP) is a well-known hemostatic agent, and recent guidelines already suggest its use in individuals exposed to antiplatelet drugs.

Francoeur et al. hypothesized that DDAVP administration in patients with SAH at admission would be associated with lower risks of intracranial aneurysm rebleeding.

They performed an observational cohort study of patients enrolled in the Columbia University SAH Outcome Project between August 1996 and July 2015. They compared the rate of rebleeding between patients who were and those who were not treated with DDAVP. After adjustment for known predictors, logistic regression was used to measure the association between treatment with DDAVP and risks of rebleeding.

Among 1639 patients with SAH, 12% were treated with DDAVP. The main indication for treatment was suspected exposure to an antiplatelet agent. The overall incidence of rebleeding was 9% (1% among patients treated with DDAVP compared with 8% among those not treated). After adjustment for antiplatelet use and known predictors, treatment with DDAVP was associated with a 45% reduction in the risks of rebleeding (adjusted OR 0.55, 95% CI 0.27-0.97). DDAVP was associated with a higher incidence of hyponatremia but not with thrombotic events or delayed cerebral ischemia.

Treatment with DDAVP was associated with a lower risk of rebleeding among patients with SAH. These findings support further study of DDAVP as first-line therapy for medical hemostasis in patients with SAH 1).


Desmopressin seems to be an effective and accepted as well as frequently adopted measure to antagonize the aspirin effect on platelet function during various major surgical procedures 2).


Bilateral inferior petrosal sinus sampling (IPSS) with desmopressin is a sensitive approach in the diagnosis of Cushing's disease (CD) and has moderate accuracy in tumour lateralization, making it an alternative choice to IPSS with CRH 3).

1)
Francoeur CL, Roh D, Schmidt JM, Mayer SA, Falo MC, Agarwal S, Connolly ES, Claassen J, Elkind MSV, Park S. Desmopressin administration and rebleeding in subarachnoid hemorrhage: analysis of an observational prospective database. J Neurosurg. 2018 Feb 2:1-7. doi: 10.3171/2017.7.JNS17990. [Epub ahead of print] PubMed PMID: 29393750.
2)
Korinth MC, Gilsbach JM, Weinzierl MR. Low-dose aspirin before spinal surgery: results of a survey among neurosurgeons in Germany. Eur Spine J. 2007 Mar;16(3):365-72. Epub 2006 Sep 5. PubMed PMID: 16953446; PubMed Central PMCID: PMC2200713.
3)
Feng M, Liu Z, Liu X, Zhang X, Bao X, Yao Y, Deng K, Xing B, Lian W, Zhu H, Lu L, Wang R. Tumour lateralization in Cushing's disease by inferior petrosal sinus sampling with desmopressin. Clin Endocrinol (Oxf). 2018 Feb;88(2):251-257. doi: 10.1111/cen.13505. Epub 2017 Nov 27. PubMed PMID: 29080355.
desmopressin.txt · Last modified: 2018/02/25 09:29 by administrador