MINIRIN / DDVAP ® - Desmopressin

MINIRIN / DDVAP ® is a drug based on Desmopressin

THERAPEUTIC GROUP: Hormones of the posterior pituitary lobe

IndicationsAction mechanismStudies and clinical effectiveness Usage and dosage instructionsWarnings Pregnancy and lactationInteractionsContraindicationsUndesirable effects

Indications MINIRIN / DDVAP ® - Desmopressin

MINIRIN / DDVAP ® is used in the treatment of diabetes insipidus, primary nocturnal enuresis, post-operative polyuria and nocturia associated with multiple sclerosis.

Desmopressin is also used in the treatment of mild and moderate haemophilia and in some types of Von Willebrand disease with the aim of increasing factor VIII concentrations.

Mechanism of action MINIRIN / DDVAP ® - Desmopressin

Desmopressin, the active ingredient of MINIRIN / DDVAP ® is an analogue of vasopressin with which it shares the same biological effects but with a longer duration of action and without vasoconstrictor effects, usually responsible for hypertensive peaks.

From the molecular point of view this molecule is able, in a similar way to vasopressin, to bind specific receptors exposed on the collecting duct, regulating its intracellular activity and facilitating phosphorylation and consequent translocation on the membrane of a protein known as AQP 2 (aquaporin 2 ), able to facilitate the passage of water from the duct to the cellular interstitium.

At the same time the aforementioned hormone acts on the cells making up the ascending tract of Henle's loop, favoring the reabsorption of sodium and therefore also due to osmotic gradient of water.

The biological effects of desmopressin are flanked by particularly advantageous pharmacokinetic properties which allow this molecule to be administered both orally and nasally and injectively.

Studies carried out and clinical efficacy

1. THE EFFICACY OF DESMOPRESSIN IN THE TREATMENT OF NICTURIA IN ELDERLY PATIENTS

Double-blind clinical trial showing that oral administration of Desmopressin, before going to bed, can be effective in reducing nocturia in elderly male patients.

2. DESMOPRESSINE AND BEHAVIORAL ASPECTS IN THE MANAGEMENT OF THE NIGHT ENURESI.

Work that reaffirms the importance of behavioral aspects in the initial treatment of primary nocturnal enuresis. The results obtained, if promptly initiated, seem to approach those achieved with desmopressin-based drug therapy.

3. THE DESMOPRESSINE IN THE KIDNEY TRANSPLANTATION

Important study that demonstrates how the pre-treatment of brain death with dopamine and desmopressin can limit renal lesions during transplantation, improving the survival and functionality of the transplanted organ.

Method of use and dosage

MINIRIN / DDVAP ®

Tablets of 0.1 - 0.2 mg of Desmopressin acetate;

Sublingual tablets of 60 - 120 mcg of Desmopressin acetate;

0.125 mg Desmopressin Acetate Nasal Spray;

4 mcg injectable preparation of Desmopressin cetate;

Oral drops of 250 mcg of Desmopressin acetate:

the dosage and the dosage schedule vary considerably from patient to patient depending on the therapeutic needs, the physio-pathological conditions and the pharmaceutical format used.

The doses used may also undergo significant changes based on clinical efficacy or the possible appearance of side effects.

Warnings MINIRIN / DDVAP ® - Desmopressin

The use of MINIRIN / DDVAP ® must be preceded by a careful medical examination to assess the patient's state of health and appropriate prescription.

It is useful that the doctor reminds the patient to significantly reduce the amount of fluids to be ingested during therapy in order to avoid a potential water poisoning, responsible for even serious side effects.

At the same time, the physician must monitor the patient's health status, proper urinary tract functioning and sodium blood concentrations throughout the therapeutic process, especially in elderly patients, in order to reduce the risk of hyponatremia.

MINIRIN / DDVAP ® contains lactose therefore it is not suitable for subjects suffering from glucose / galactose malabsorption syndrome, lactase enzyme deficiency or galactosemia.

PREGNANCY AND BREASTFEEDING

Despite the studies present at the time do not seem to report side effects on the fetus related to the intake of desmopressin in the pregnant woman, the absence of statistically significant data does not allow the free use of these drugs during pregnancy.

Interactions

The particular biological activity of desmopressin could be responsible for clinically relevant drug interactions.

More precisely, the simultaneous intake of loperamide and analgesics could determine an increase in the blood concentrations of desmopressin when taken orally, with a consequent accentuation of the biological effects of the drug.

The simultaneous intake of tricyclic antidepressants, inhibitors of serotonin re-uptake, carbamazepine and chlorpromazine could increase the risk of water retention and hyponatremia.

Contraindications MINIRIN / DDVAP ® - Desmopressin

The use of MINIRIN / DDVAP ® is contraindicated in patients suffering from polyuria associated with usual or psychogenic polydipsia, proven heart failure, moderate and severe renal insufficiency, hyponatremia, syndrome of inappropriate ADH secretion and in case of hypersensitivity to the active ingredient or to one of his excipients.

Undesirable effects - Side effects

Different clinical trials and careful post-marketing monitoring have shown that taking MINIRIN / DDVAP ® according to the indications of the specialist doctor may be without significant side effects.

The most frequently observed adverse reactions were headache, abdominal pain and nausea.

However, it is useful to remember that it is necessary to reduce the ingestion of liquids during treatment with MINIRIN / DDVAP ® in order to avoid water retention and hyponatremia often accompanied by headache, nausea, weight gain and in severe cases convulsions.