Desmopressin
Desmopressin (DDAVP) is a synthetic analogue of the endogenous hormone vasopressin (antidiuretic hormone, ADH). Deamination of the first amino acid and substitution of L-arginine with D-arginine give it selective activity at the V2 receptor with strongly reduced pressor (V1) activity. It has been approved for decades for indications including central diabetes insipidus, primary nocturnal enuresis, and bleeding tendency in von Willebrand disease type 1 and mild haemophilia A. The principal safety concern is hyponatremia or water intoxication.
Mechanism of action
Desmopressin is a structurally modified analogue of the nine-residue peptide hormone vasopressin. Deamination at the N-terminus (1-deamino) and replacement of L-arginine by D-arginine at position 8 prolong the duration of action and render the compound largely selective for the vasopressin V2 receptor, while the V1-mediated vasoconstrictive effect is strongly reduced. Acting on V2 receptors in the renal collecting ducts, it promotes insertion of aquaporin-2 water channels into the apical membrane, increasing water reabsorption and reducing urine volume (antidiuretic effect). In addition, via V2 receptors on the vascular endothelium, desmopressin stimulates the release of von Willebrand factor and factor VIII from endothelial stores (Weibel-Palade bodies), improving primary haemostasis.
L'evidenza in sintesi
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Dove gli studi divergono
Does the benefit in nocturia/enuresis justify the hyponatremia risk?
Farmacocinetica
Curva teorica di concentrazione con un'emivita di 3 h. Modello puramente farmacocinetico — non una raccomandazione di dose.
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Interazioni e combinazioni
Voci regolatorie
Desmopressin can lead to water retention and consequent hyponatremia; careful restriction of fluid intake and monitoring of serum sodium are emphasised in the labeling.
Osservazioni aneddotiche
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Calcolatore di ricostituzione
I peptidi arrivano come polvere secca. Una volta disciolti in un liquido (ricostituzione), questo calcolatore risponde a una sola domanda: quanta sostanza c'è in un millilitro di soluzione dopo?
- 1Inserisci la quantità di sostanza del flacone (riportata sull'etichetta).
- 2Inserisci quanto solvente aggiungi.
- 3Risultato = concentrazione in mg per mL.
Registro degli studi
Oral desmopressin: a randomized double-blind placebo controlled study of effectiveness in children with primary nocturnal enuresis
Quantification of the relationship between desmopressin concentration and Von Willebrand factor in Von Willebrand disease type 1: A pharmacodynamic study
Evaluation of high concentration intranasal and intravenous desmopressin in pediatric patients with mild hemophilia A or mild-to-moderate type 1 von Willebrand disease
Oral desmopressin treatment of central diabetes insipidus in children
Fonti e metodologia
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