Name of the Antidiuretic hormone and its analogues Drugs
- Vasopressin
- Desmopressin
- Terlipressin
1.Vasopressin
| Vasopressin |
| Availability injection solution for dilution 20 units/mL (3-mL single-dose vial; 10-mL multidose vial); further dilution required /100mL injection solution, ready-to-use 20 units/100mL (0.2 units/mL) 40 units/100mL (0.4 units/mL) 60 units/100mL (0.6 units/mL) |
| Indications and Dosages To prevent or control symptoms of central diabetes insipidus caused by insufficient Adults. 5 to 10 units b.i.d. or t.i.d., as needed. Children. 2.5 to 10 units t.i.d. or q.i.d., as needed. To prevent or treat abdominal distention Adults. 5 units, increased to 10 units every 3 to 4 hr, as needed. |
Mechanism of Action
Vasopressin, a synthetic form of antidiuretic hormone, treats diabetes insipidus by decreasing urine output and raising urine osmolality. When vasopressin attaches to vasopressin2 (V2) receptors on cell membranes in the nephron’s collecting duct, it activates the enzyme adenyl cyclase to convert adenosine triphosphate (ATP) to cyclic adenosine monophosphate (cAMP). This action increases the collecting duct’s permeability and enhances water reabsorption into the blood
Pharmacokinetics
Bioavailability: Destroyed by trypsin in GI tract; must be administered parenterally or intranasally
Metabolized in liver and kidney; rapidly removed from plasma
Half-life: 10-20 min (parenteral)
Excretion: Urine (5-10%)
Contraindications
Chronic nephritis with nitrogen retention, hypersensitivity to vasopressin or its components
Adverse Reactions
- CNS: Dizziness, headache, light-headedness, tremor
- CV: Angina, MI EENT: Circumoral pallor
- ENDO: Water intoxication
- GI: Abdominal cramps, diarrhea, eructation, flatulence, intestinal hypermotility, nausea, vomiting
- SKIN: Diaphoresis, pallor
- Other: Allergic reaction
Nursing Considerations
- Use vasopressin with extreme caution in patients with coronary artery disease because it may cause angina or MI; in those with hypertension because it may increase blood pressure; and in those with asthma, epilepsy, heart failure, or migraine headache because extracellular fluid may increase rapidly.
- Monitor fluid and electrolyte balance during therapy. Check intake and output at least every 8 hours, and watch for evidence of water intoxication and hyponatremia, including anuria, confusion, drowsiness, headache, listlessness, and weight gain
Patient Teaching
- Teach patient how to administer vasopressin; stress the need to rotate injection sites.
- Urge patient to notify prescriber immediately if he has evidence of possible water intoxication, including anuria, confusion, drowsiness, headache, listlessness, and unexplained weight gain.
- Inform patient that abdominal cramps, nausea, and skin blanching will subside after a few minutes and can be minimized by drinking one or two glasses of water
2.Desmopressin
| Desmopressin |
| Availability Injection: 4 mcg/ml in single-dose 1-ml ampules and multidose 10-ml vials Intranasal solution: 0.1 mg/ml, 1.5 mg/ ml Intranasal spray (DDAVP): 0.1 mg/ml (10 mcg/spray) in 5-ml spray pump bottle Tablets: 0.1 mg, 0.2 mg |
| Indications and dosages ➣ Diabetes insipidus Adults and children older than age 12: 0.05 mg P.O. b.i.d.; adjust dosage based on patient response. Or 0.1 to 0.4 ml (10 to 40 mcg) daily intranasally as a single dose or in two or three divided doses. Or 0.5 ml (2 mcg) to 1 ml (4 mcg) daily I.V. or subcutaneously, usually in two divided doses. Children ages 3 months to 12 years: 0.05 to 0.3 ml/day intranasally in one or two divided doses ➣ Hemophilia A; von Willebrand’s disease type I Adults and children: 0.3 mcg/kg I.V.; may repeat dose if needed. Or 300 mcg of intranasal solution containing 1.5 mcg/ml; for patients weighing less than 50 kg (110 lb), total dosage of 150 mcg (one spray of solution containing 1.5 mg/ml into a single nostril) is usually sufficient. If needed to maintain hemostasis during surgery, give intranasal dose 2 hours before surgery or give I.V. dose 30 minutes before surgery. |
Mechanism of Action
Exerts an antidiuretic effect similar to that of vasopressin by increasing cellular permeability of renal collecting ducts and distal tubules, thus enhancing water reabsorption, reducing urine flow, and increasing osmolality. As an antihemorrhagic, drug increases blood level of clotting factor VIII (antihemophilic factor) and activity of von Willebrand factor (factor VIIVWF). It also may increase platelet aggregation and adhesion at injury sites by directly affecting blood vessel walls
Pharmacokinetics
- Bioavailability: 3.3-4.1% (Stimate); 3.5% (nasal); 5% (oral; compared to intranasal, 0.16% compared to IV); 0.25 (SL)
- Peak plasma time: 1-5 hr (intranasal); 0.25 hr for 0.83 mcg dose and 0.75 hr for 1.66 mcg dose (preservative-free nasal spray)
- Metabolism: Unknown
- Half-life: 3.3-3.5 hr (intranasal); 3 hr (IV, healthy patient); 9 hr (IV, severe renal impairment); 2-3 hr (PO); 2.8 hr (1.66 mcg dose; preservative-free nasal spray): 2.8 hr (SL)
- Excretion (IV): Urine (52%)
Administration
- Adjust morning and evening dosages as appropriate to minimize frequent urination and risk of water intoxication.
- Give I.V. dose (diluted in normal saline solution) by infusion over 15 to 30 minutes.
- Monitor pulse and blood pressure throughout I.V. infusion
- When giving to child with diabetes insipidus, carefully restrict fluid intake
Contraindications
- Hypersensitivity to drug
- Moderate to severe renal impairment
- Hemophilia A with factor VIII levels less than or equal to 5%
- Von Willebrand’s disease type IIB
- Impaired level of consciousness (intranasal form)
Precautions:
- Coronary artery disease, hypertensive cardiovascular disease, fluid and electrolyte imbalances
- Breastfeeding patients.
Adverse reactions
- CNS: headache, dizziness, insomnia
- CV: slight blood pressure increase, chest pain, palpitations
- EENT: rhinitis, epistaxis, sore throat
- GI: nausea, abdominal pain
- GU: vulvar pain
- Respiratory: cough
- Other: local erythema, flushing, swelling or burning after injection
Patient monitoring
- Monitor urine volume and specific gravity, plasma and urine osmolality, and electrolyte levels in patients with diabetes insipidus.
- Monitor factor VIII antigen levels, activated partial thromboplastin time, and bleeding time in patients with hemophilia. ●When giving to child with diabetes insipidus, carefully monitor fluid intake and output
Patient teaching
- Instruct patient to take drug exactly as prescribed and not to interchange strengths or delivery systems.
- Teach patient how to use prescribed delivery system if taking drug by other than oral route.
- Instruct patient with diabetes insipidus to avoid overhydration and to weigh himself daily. Tell him to report weight gain or swelling of arms or legs.
- If patient is using nasal spray, teach him to inspect nasal membranes regularly and to report increased nasal congestion or swelling.
- Caution elderly patient not to increase fluid intake beyond that sufficient to satisfy thirst.
- Instruct patient to report headache, respiratory difficulty, nausea, or abdominal pain to prescriber.
- As appropriate, review all significant adverse reactions and interactions, especially those related to the drugs mentioned above.
Nursing Considerations
- Use desmopressin cautiously in patients with conditions associated with fluid and electrolyte imbalance, such as cystic fibrosis, heart failure, and renal disorders; these patients are prone to hyponatremia.
- Also use cautiously in patients with habitual or psychogenic polydipsia; they may be more likely to drink excessive water, raising the risk of hyponatremia.
- Nasal cavity scarring, edema, and other abnormalities may cause erratic absorption and require a different administration route.
- Check blood pressure often during therapy
3.Terlipressin
| Terlipressin |
| Availability injection, lyophilized powder for reconstitution 0.85mg/vial |
| Indications and dosages Hepatorenal Syndrome Days 1-3: 0.85 mg slow IV bolus q6hr |
Mechanism of Action
Synthetic vasopressin analogue with twice the selectivity for vasopressin V1 receptors versus V2 receptors
Acts as both a prodrug of lysine-vasopressin, as well as having pharmacologic activity on its own
Thought to increase renal blood flow in patients with hepatorenal syndrome by reducing portal hypertension and blood circulation in portal vessels and increasing effective arterial volume and mean arterial pressure (MAP)
Pharmacokinetics
Peak plasma concentration (steady state): 70.5 ng/mL
Metabolized by cleavage of N-terminal glycyl residues of terlipressin by various tissue peptidases, resulting in release of pharmacologically active metabolite lysine-vasopressin
Half-life: 0.9 hr; 3 hr (lysine-vasopressin)
Excretion: Urine <1%; <0.1% (lysine-vasopressin) in healthy subjects
Contraindications
- Patients experiencing hypoxia or worsening respiratory symptoms
- Patients with ongoing coronary, peripheral, or mesenteric ischemia
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
