Desmopressin

Products

Desmopressin is commercially available as a solution for injection, in the form of nasal drops, as a nasal spray, tablets, and sublingual tablets (e.g., Minirin, Nocutil, other drugs). It has been approved in many countries since 1973.

Structure and properties

Desmopressin (C48H68N14O14S2, Mr = 1129.3 g/mol) is present in the drugs as desmopressin acetate, a white, loose powder that is soluble in water. It is a cyclic nonapeptide with the following sequence:

  • Desmopressin: 3-mercaptopropionyl-Tyr-Phe-Gln-Asn-Cys-Pro-D-Arg-Gly-NH2.
  • Vasopressin: Cys-Tyr-Phe-Gln-Asn-Cys-Pro-L-Arg-Gly-NH2

Desmopressin is a synthetic analog of antidiuretic hormone (ADH) vasopressin in which the amino group of the cysteine in position 1 of the peptide has been removed and L-arginine in position 8 has been replaced by D-arginine (1-deamino-8-D-arginine vasopressin). ADH is a natural hormone secreted by the posterior pituitary gland.

Effects

Desmopressin (ATC H01BA02) has antidiuretic properties. It has a longer duration of action and less effect on the vasculature, blood pressure, and uterus compared with the natural hormone vasopressin. The hormone vasopressin increases the reabsorption of water at the collecting tube of the nephron in the kidney and has vasovagal properties, which increases blood pressure. Furthermore, vasopressin also exerts functions in the central nervous system. It has a short half-life.

Indications

  • Bedwetting (enuresis nocturna)
  • Nocturia due to idiopathic nocturnal polyuria in adults.
  • Diabetes insipidus centralis

Other indications:

  • Investigation of the concentration capacity of the kidneys (diagnosis of diabetes insipidus).
  • Preoperative and posttraumatic increase of factor VIII and von Willebrand factor in mild to moderate hemophilia A and von Willebrand disease type I.
  • To shorten bleeding time in uremic platelet dysfunction.

Not all dosage forms are approved for all indications.

Dosage

According to the SmPC. Drugs are administered parenterally, perorally, intranasally, and sublingually.

Contraindications

Refer to the drug label for complete precautions.

Adverse effects

The most common possible adverse effects include: