Desmopressin (DDAVP, DesmoMelt, Minirin, Minirin Melt, Octim, Stimate)

Indications

Diabetes Insipidus (DI) (see Diabetes Insipidus)

  • xxx

Hemophilia A (see Hemophilia A)

  • xxx

Management of “Autocorrection” During the Treatment of Hyponatremia (see Hyponatremia)

  • Pharmacology
    • Desmopressin Binds to Renal Collecting Duct Vasopressin V2 Receptors (Resulting in its “Antidiuretic” Activity), Inducing an Iatrogenic Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), Allowing from a More Controlled Increase in the Serum Sodium While Using Hypertonic (3%) Saline

Platelet Dysfunction Following Cardiopulmonary Bypass (see Cardiopulmonary Bypass)

  • xxx

Primary Nocturnal Enuresis

  • xxx

Uremic Platelet Dysfunction (see xxxx)

  • Off-Label Use

Von Willebrand Disease (see Von Willebrand Disease)

  • xxx

Contraindications

  • Von Willebrand Disease Type 2B (see Von Willebrand Disease): desmopressin may induce platelet aggregation, thrombocytopenia, and possibly thrombosis

Pharmacology

Desmopressin (DDAVP = 1-Deamino-8-D-Arginine Vasopressin) is a Synthetic analogue of Human 8-Arginine Vasopressin (i.e. Antidiuretic Hormone, ADH)

Structure

  • Compared to Vasopressin, the First Amino Acid of Desmopressin Has Been Deaminated and the Arginine at the 8th Position is in the Dextro (Rather than the Levo) Configuration
  • Due to Their Structural Differences, Vasopressin and Desmopressin Exhibit Distinct Receptor Binding Abilities
    • Vasopressin Binds to Both the V1a and V2 Receptors
    • Desmopressin Binds to Only the V2 Receptors (Which Primarily Mediates the Antidiuretic Response), But Not the V1a Receptors

Effects of Desmopressin on Renal Collecting Duct V2 Receptors

  • Desmopressin Binds to Renal Collecting Duct V2 Receptors, Resulting in “Antidiuretic” Effects
    • Decreased Urine Volume
    • Increased Urine Osmolality

Effects of Desmopressin on Endothelial Cell V2 Receptors

  • Desmopressin Binds to Endothelial Cell V2 Receptors, Stimulating Von Willebrand Factor and tPA Release from Endothelial Cell Weibel Palade Bodies
    • Von Willebrand Factor and tPA are Normally Stored in Weibel Palade Bodies
  • Desmopressin Results in Increased Endothelial Cell Factor VIII Release (Via an Unknown Mechanism)
    • Desmopressin is More Potent Than Vasopressin in Increasing Plasma Factor VIII Activity

Effects of Desmopressin on Vasoconstriction/Blood Pressure and the Uterus

  • Compared to Vasopressin, Desmopressin Has Little Effect on Vasoconstriction/Blood Pressure or the Uterus (see Vasopressin)

Metabolism

  • Unclear
    • Not affected by hepatic microsomal P450 enzymes
    • Desmopressin is Degraded More Slowly Than Recombinant Vasopressin: requires less frequent administration

Administration

Intravenous Treatment of Uremic Platelet Dysfunction (see xxxx): 0.3 μg/kg

  • Alternatively, Subcutaneous Administration Can Be Used (Although it is Less Preferred)

Intravenous Management of “Autocorrection” During the Treatment of Hyponatremia (see Hyponatremia)

  • Proactive (Preventative) Strategy/Reactive Strategy: 1-2 μg q6-8hrs x 24-48 hrs
  • Rescue Strategy: 2 μg q6 hrs

Dose Adjustment

  • Hepatic: none
  • Renal
    • CrCl <50 mL/min: although use is contraindicated in manufacturer labeling, use of desmopressin in common in this population for the treatment of uremic platelet dysfunction

Use in Pregnancy (see Pregnancy)

  • xxx

Use During Lactation

  • xxx

Adverse Effects

Cardiovascular Adverse Effects

  • Acute Myocardial Infarction (see Coronary Artery Disease)
    • Epidemiology:
      • Associated with Intravenous Administration
    • Physiology: thrombotic event
  • Hypertension (see Hypertension)
    • Epidemiology
      • Associated with Intravenous Administration
  • Hypotension (see Hypotension)
    • Epidemiology
      • Associated with Intravenous Administration (Particularly with Rapid Infusion)

Dermatologic Adverse Effects

  • Facial Flushing (see Flushing)
    • Epidemiology
      • Associated with Intravenous Administration

Neurologic Adverse Effects

Renal Adverse Effects


References

  • Cellular mechanisms of the hemostatic effects of desmopressin (DDAVP). J Thromb Haemost. 2003 Apr;1(4):682-9 [MEDLINE]
  • The use of desmopressin in open-heart surgery. Haemophilia 2008; 14(Suppl) 1: S40–S47