Desmopressin (trade names: DDAVP, Stimate, Minirin) is a synthetic replacement for antidiuretic hormone, the hormone that reduces urine production during sleep. It may be taken nasally, intravenously, or as a pill. Doctors prescribe Desmopressin most frequently for treatment of diabetes insipidus or bedwetting.

In December 2007, US drug regulators banned using desmopressin nasal sprays for treating bedwetting, but said that desmopressin pills are still a safe bedwetting treatment for otherwise healthy patients. The regulators reviewed the drug after two patients using desmopressin nasal sprays died from hyponatremia, an imbalance of sodium levels in the body. http://www.webmd.com/news/20071204/2-deaths-spur-bedwetting-drug-warning

Chemistry

Desmopressin (1-desamino-8-D-arginine vasopressin) is a modified form of the normal human hormone arginine vasopressin, a peptide containing nine amino acids.

Compared to vasopressin, desmopressin's first amino acid has been deaminated, and the arginine at the eighth position is in the dextro rather than the levo form (see stereochemistry).

Mode of action

Desmopressin works by limiting the amount of water that is eliminated in the urine.

Desmopressin binds to V2 receptors in renal collecting ducts, increasing water resorption. It also stimulates release of factor VIII from endothelial cells due to stimulation of the V1a receptor.

Desmopressin is degraded more slowly than recombinant vasopressin, and requires less frequent administration. In addition, it has little effect on blood pressure, while vasopressin may cause arterial hypertension.

Clinical uses

Bedwetting

Doctors prescribe desmopressin frequently for treatment of bedwetting. It is usually in the form of Desmopressin acetate, DDAVP. Patients taking DDAVP are 4.5 times more likely to stay dry than those taking a placebo. http://www.bmj.com/cgi/content/full/323/7322/1167?view=full&pmid=11711411#SEC6 The drug replaces the antidiuretic hormone for a single night with no cumulative effect.

US drug regulators banned treating bedwetting with desmopressin nasal sprays after two patients died and 59 other patients suffered seizures. The patients were using desmopressin when they developed Hyponatremia, an imbalance of the body's sodium levels. http://www.webmd.com/news/20071204/2-deaths-spur-bedwetting-drug-warning

FDA regulators said that desmopressin pills could still be considered safe for bedwetting treatment, as long as the patient was otherwise healthy. Patients must stop taking desmopressin if they become sick and have severe vomiting and diarrhea, fever, the flu, or severe cold. They should also be very cautious during hot weather or following strenuous exercise that may make them thirsty.

This is because desmopressin works by limiting the amount of water that is eliminated in the urine. A healthy body needs to maintain a balance of water and salt (sodium). If sodium levels become too low (hyponatremia) - either as a result or increased water take-up or reduced salt levels - a person may have seizures and, in extreme cases, may die. http://www.fda.gov/cder/drug/InfoSheets/HCP/desmopressinHCP.htm

Coagulation disorders

Desmopressing can be used to promote the release of von Willebrand factor and factor VIII in patients with coagulation disorders such as type I von Willebrand disease, mild hemophilia A, and thrombocytopenia. It is not effective in the treatment of hemophilia B or severe hemophilia A.

Diabetes insipidus

Desmopressin is also used to reduce urine production in central diabetes insipidus patients.

Side effects

• headaches
• facial flushing
• nausea
• hyponatremia

Desmopressin nasal is in the FDA pregnancy category B. Drugs in this category are not expected to harm an unborn baby.

See also

• diabetes insipidus
• hemophilia A
• von Willebrand disease

References

• Leissinger C, Becton D, Cornell C Jr, Cox Gill J. High-dose DDAVP intranasal spray (Stimate) for the prevention and treatment of bleeding in patients with mild haemophilia A, mild or moderate type 1 von Willebrand disease and symptomatic carriers of haemophilia A. Haemophilia 2001;7:258-66. PMID 11380629.

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