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

Indications

Diabetes Insipidus (DI) (see Diabetes Insipidus, [[Diabetes Insipidus]])

  • xxx

Hemophilia A (see Hemophilia A, [[Hemophilia A]])

  • xxx

Platelet Dysfunction Following Cardiopulmonary Bypass (see Cardiopulmonary Bypass, [[Cardiopulmonary Bypass]])

  • xxx

Primary Nocturnal Enuresis

  • xxx

Uremic Platelet Dysfunction (see xxxx, [[xxxx]])

  • Off-Label Use

Von Willebrand Disease (see Von Willebrand Disease, [[Von Willebrand Disease]])

  • xxx

Contraindications

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

Pharmacology

  • Desmopressin (DDAVP = 1-Deamino-8-D-Arginine Vasopressin): synthetic analogue of human 8-arginine vasopressin (anti-diuretic hormone, ADH) -> however, 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
    • Desmopressin Binds to Endothelial Cell V2 Receptors, Stimulating Von Willebrand Factor and tPA Release from Endothelial Cell Weibel Palade Bodies: where both Von Willebrand factor and tPA are stored
    • 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
    • Desmopressin Binds to V2 Receptors in Renal Collecting Duct: resulting in decreased urine volume and increased urine osmolality
    • Compared to its Analogue, Vasopressin, Desmopressin Has Little Effect on Blood Pressure, Vasoconstriction, or the Uterus (see Vasopressin, [[Vasopressin]])

Metabolism

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

Administration

  • IV (Treatment of Uremic Platelet Dysfunction): 0.3 μg/kg
    • Alternatively, SQ Administration Can Be Used (Although it is Less Preferred)

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

Adverse Effects

Cardiovascular Adverse Effects

  • Acute Myocardial Infarction (see xxxx, [[xxxx]])
    • Epidemiology: associated with intravenous administration
    • Physiology: thrombotic event
  • Hypertension (see Hypertension, [[Hypertension]])
    • Epidemiology: associated with intravenous administration
  • Hypotension (see Hypotension, [[Hypotension]])
    • Epidemiology: associated with intravenous administration (particularly with rapid infusion)

Dermatologic Adverse Effects

  • Facial Flushing (see Flushing, [[Flushing]])
    • Epidemiology: associated with intravenous administration

Neurologic Adverse Effects

  • Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident, [[Ischemic Cerebrovascular Accident]])
    • Epidemiology: associated with intravenous administration
    • Physiology: thrombotic event

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