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Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
The frequency of birth defects in 157 infants exposed to DDAVP (desmopressin) was not increased in the Swedish Birth Defects Registry (Kallen, 2019). An earlier study on birth defects in 29 infants who were exposed to desmopressin or vasopressin found one birth defect (Kallen et al., 1995). In a published literature review, 49 infants exposed to desmopressin (DDAVP) during organogenesis were found, and three had one had a major birth defect, and unrelated chromosomal abnormalities (trisomy 21) (Ray, 1998). A recent literature review reported that among 35 infants in 32 different studies exposed to desmopressin during the first trimester, no birth defects occurred. However, the C-section rate was 54 percent (Kyriakos et al., 2021).
Urinary tract disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Desmopressin is a synthetic analogue of vasopressin, which has an antidiuretic effect. It is available in oral tablet, sublingual and intranasal formulations. Trial data suggest approximately 0.5 fewer voids per night and one hour longer sleep duration before first void compared to placebo.142 Hyponatraemia is a recognised adverse effect (RR 5.1; 95% CI 3.0–8.8) with an incidence highest after two to three weeks of therapy. Desmopressin should be discontinued if serum sodium drops below the normal range. Users need to fluid restrict concurrently and avoid other medications that could induce SIADH (e.g. antidepressants and carbamazepine). Current guidance recommends avoiding desmopressin in people aged over 65 with a history of cardiovascular disease or hypertension.87 Given the risk of adverse effects, it is unlikely to be suitable for frail older people with nocturia.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Desmopressin is a synthetic agonist of the neuropeptide vasopressin with enhanced antidiuretic properties [13,14]. Thanks to its safety, it has replaced imipramine in the pharmacological approach to enuresis. Desmopressin mainly acts by reducing nocturnal urine production via direct vasopressin effects [15]. It may also act by improving the patient’s ability to awaken and improve bladder instability; indeed studies have demonstrated that vasopressin facilitates arousal in humans and also appears to increase motor activity and stabilise unstable bladders in rats. Given orally at a dose of 200 to 400 microg (tablets 100 and 200 microg), or intranasally at a dose of 20 to 40 microg (2 to 4 sprays) for a period of -3 months, desmopressin is effective in 50 to 80% of patients with monosymptomatic nocturnal enuresis. Unfortunately, such treatment is associated with a high relapse rate. Desmopressin has minor side effects including headache, mild abdominal cramp, nausea, nasal congestion, epistaxis, reversible body weight gain; water intoxication with hyponatremia and convulsions have been reported in a few cases. Children with a family history of nocturnal enuresis and a high nocturnal urine output seem to be good responders to desmopressin: Nørgaard et al. have shown that 91% of enuretic patients with a family history of enuresis compared with only 71% of those without are responders to desmopressin [16].
Pharmacotherapeutic options in the treatment of nocturia: an update on the current oral drug therapies
Published in Expert Opinion on Pharmacotherapy, 2022
Desmopressin is a synthetic analog of vasopressin receptor agonist that is an effective anti-diuretic medical therapy without major vasopressor side effects. Desmopressin binds to V2 receptors in the renal collecting duct tubules to prevent nocturnal urine production and water diuresis, thus making it an effective drug therapy to treat conditions related to nocturnal sodium diuresis such as central diabetes insipidus, or in patients with excessive water diuresis (9). While desmopressin is available in formulations for nasal, oral or intravenous administration, the oral desmopressin lyophilisate formulation (Nocdurna®) is currently the most popular preparation since it can be consumed without concomitant fluid intake. To date, desmopressin remains the only drug to receive a strong recommendation by the International Consultation on Incontinence (ICI) committee for treating nocturnal polyuria [11].
Nocturia in female patients: Current clinical features, treatment patterns and outcomes at a tertiary referral centre
Published in Arab Journal of Urology, 2019
Siri Drangsholt, Benoit Peyronnet, Maria Arcila-Ruiz, Rachael D. Sussman, Ricardo Palmerola, Dominique R. Pape, Nirit Rosenblum, Victor W. Nitti, Benjamin M. Brucker
Medication directed towards overproduction of urine could be regarded as a promising option for improving the outcomes of nocturia therapeutic management. Desmopressin, an analogue of arginine vasopressin, treats excessive urine production by increasing fluid reabsorption by the kidney leading to more concentrated urine production. Despite having been available for years, the formulations of desmopressin on the market over the study period were used in only 5.1% of the women, probably because of a lack of regulatory approval for nocturia, unpredictable pharmokenetics, and fear of associated side-effects [14]. The introduction of recently approved desmopressin formulations may change nocturia treatment patterns [15,16]. Newly engineered medications have highly predicable pharmokenetics profile and thus lower rates of hyponatraemia, with the same effect as available desmopressin tablets [15,16,17]. Further ‘real-life’ studies will be needed to determine if the recent approval of these new therapies will translate into a larger use of desmopressin containing medications, and ultimately in enhanced pharmacological benefits in female patients with nocturia.
Desmopressin and nocturnal voiding dysfunction: Clinical evidence and safety profile in the treatment of nocturia
Published in Expert Opinion on Pharmacotherapy, 2018
A systematic review and meta-analysis of desmopressin for the treatment of nocturia [49] revealed five studies involving 619 participants were included for the meta-analysis and eight RCTs of cross-over design were also identified for the systematic review. The analysis showed that desmopressin can significantly decrease the frequency of nocturnal voids, nocturnal urine volume, and nocturnal diuresis, potentially resulting in an extended duration of the first sleep period and improved sleep quality. The adverse effects of desmopressin were no different to those observed in the placebo group. Recent Cochrane review showed that desmopressin may have a positive effect on the number of nocturnal voids (mean difference (MD) −0.46, 95% CI −0.94 to 0.01; low-quality evidence) in the shorter term [50]. For intermediate-term follow-up (3–12 months), desmopressin may reduce the number of nocturnal voids in an appreciable number of participants (MD −0.85, 95% CI −1.17 to −0.53; low-quality evidence) with little or no difference in major adverse events (RR 3.05, 95% CI 0.13–73.39; low-quality evidence). Subgroup analyses suggest a larger effect with oral, higher-dose formulations of desmopressin especially in men with NP.