Desmopressin

Desmopressin (des-amino-D-arginine vasopressin) (DDAVP) has two major advantages: the vasoconstrictor effect has been reduced to near insignificance and the duration of action with nasal instillation, spray or s.c. injection, is 8-20 h (tV2 75 min) so that, using it once to twice daily, patients are not inconvenienced by frequent recurrence of polyuria during their waking hours and can also expect to spend the night continuously in bed. The adult dose for intranasal administration is 10-20 micrograms daily. The dose for children is about half that for adults. The bioavailability of intranasal DDAVP is 10%. It is also the only peptide for which an oral formulation is currently available, albeit with a bioavailability of only 1%. The tablets of DDAVP are prescribed initially at 300-600 micrograms daily in three divided doses. The main complication of DDAVP is hypona-traemia which can be prevented by allowing the patient to develop some polyuria for a short period during each week. The requirement for DDAVP may decrease during intercurrent illness.

Nephrogenic diabetes insipidus, as is to be expected, does not respond to antidiuretic hormone.

In bleeding oesophageal varices in hepatic cirrhosis, use is made of the vasoconstrictor effect of vasopressin (as terlipressin, a vasopressin prodrug): see page 654.

In haemophilia desmopressin can enhance blood concentration of factor VIII. Felypressin is used as a vaso constriction with local anaesthetics.

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