Desmopressin is a synthetic analogue of arginine vasopressin (antidiuretic hormone, ADH). Its principal action is to increase water reabsorption in the kidneys, thereby reducing urine production. It also increases circulating factor VIII and von Willebrand factor, making it useful in selected bleeding disorders. Desmopressin is available in several formulations, including tablets, nasal preparations, and injectable products, with indications and dosing varying by formulation.
Key Points
Drug class: Synthetic vasopressin analogue
Primary mechanism: Activates V2 receptors in the renal collecting ducts, promoting water reabsorption.
Hemostatic action: Increases release of factor VIII and von Willebrand factor from endothelial storage sites.
Major indications: Central diabetes insipidus, selected cases of mild-to-moderate type 1 von Willebrand disease, and hemophilia A with adequate baseline factor VIII activity.
Administration: Oral, intranasal, subcutaneous, or intravenous depending on the product and indication.
Common adverse effects: Headache, nausea, abdominal discomfort, and fluid retention.
Major safety concern:Hyponatremia caused by excessive water retention can be severe and potentially life-threatening.
Monitoring: Serum sodium should be appropriately monitored, particularly in patients at increased risk of hyponatremia.
Important limitation: Desmopressin is ineffective and is not indicated for nephrogenic diabetes insipidus.
Specifications
Generic name: Desmopressin
Common pharmaceutical form: Desmopressin acetate
Chemical class: Modified peptide hormone analogue
Molecular formula:C₄₆H₆₄N₁₄O₁₂S₂ for desmopressin; acetate salts have additional acetate components.
Molecular weight: Approximately 1,129.27 g/mol for desmopressin acetate in one listed form.
Dosage forms: Tablets, nasal spray, and injection
Injection strength:4 mcg/mL in listed injectable products.
Nasal spray strength: Certain products deliver 10 mcg per spray.
Routes: Oral, intranasal, subcutaneous, and intravenous
Initial U.S. approval:1978 for injectable desmopressin.
Important: Desmopressin should be used under medical supervision because fluid restriction and sodium monitoring may be necessary. Severe hyponatremia can cause seizures, coma, or other life-threatening complications.
