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Desmopressin acetate tablet, also known as Mi Ning, is an artificially synthesized water-regulating hormone analogue mainly used to treat diseases related to water salt imbalance. Its core components are significantly enhanced in antidiuretic effect and prolonged in duration by structural modification, namely deamination of 1-cysteine and substitution of 8-L-arginine with 8-D-arginine, while avoiding the vasoconstrictive side effects of natural hormones.
This drug activates the V2 receptor on the renal collecting duct, promotes the expression of aquaporin-2, increases water reabsorption, thereby reducing urine excretion and concentrating urine. It has a wide range of indications, including deficient antidiuretic hormone secretion, nocturnal enuresis in children aged 6 and above, prevention of surgical bleeding in hemophilia A and vascular hemophilia sick persons, as well as prolonged bleeding time caused by platelet dysfunction due to cirrhosis or uremia. In addition, it can also be used for renal urine concentration function tests to assist in the diagnosis of renal dysfunction.
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Desmopressin Acetate COA
Assessment of renal concentration function
The renal concentration function is one of the core abilities of the kidneys to regulate water salt balance, and its evaluation is of great significance for the diagnosis of diseases such as renal diabetes insipidus, chronic glomerulonephritis, and chronic renal failure. Traditional evaluation methods include water tests, urine osmotic pressure measurements, etc., but these methods may be affected by factors such as sick person compliance and underlying diseases. Desmopressin acetate tablet as a synthetic analogue of water-regulating hormone (ADH), enhances renal reabsorption of water by simulating the action of ADH, becoming an important tool for evaluating renal concentration function.
specific application
Experimental Design
Water restriction stage:
Sick person need to start fasting and water restriction on the eve of the experiment for 8-12 hours to eliminate the interference of diet on urine osmotic pressure.
Baseline testing:
After the end of the water ban, collect morning urine samples to measure baseline urine osmotic pressure (Uosm) and blood osmotic pressure (Posm), and record vital signs such as body weight and blood pressure.
Drug intervention:
Intranasal spray (usually 10-20 μ g) was given, and urine samples were collected every 30 minutes within 1-2 hours after administration to continuously monitor the changes of Uosm.
Termination condition:
If Uosm reaches its peak (usually ≥ 800 mOsm/kg) or the sick person exhibits symptoms of hyponatremia (such as headache, nausea), the trial must be terminated immediately and fluid should be replenished.
Evaluation Metrics
Urinary osmotic pressure response:Under ADH stimulation, Uosm in normal kidneys should significantly increase (usually by more than 50%). If the response is slow or unresponsive, it indicates impaired renal concentration function.Urine/blood osmotic pressure ratio (Uosm/Posm):In healthy individuals, this ratio should be greater than 2.5. If it is less than 1.5, it may indicate renal diabetes insipidus.Changes in blood sodium:ADH over action may lead to water retention and hyponatremia, so it is necessary to closely monitor the blood sodium level (normal range: 135-145 mmol/L).
Clinical significance
Diagnosis of renal diabetes insipidus:Distinguish between deficient antidiuretic hormone secretion (ADH deficiency) and renal diabetes insipidus (kidney insensitivity to ADH). The former showed a significant increase in Uosm after medication, while the latter showed no response.Chronic renal disease monitoring:To evaluate the renal concentration function of sick person with chronic glomerulonephritis, diabetes nephropathy, etc., and guide treatment and prognosis judgment.Drug efficacy evaluation:Monitor the toxic effects of certain drugs (such as lithium salts) on the kidneys and adjust treatment plans in a timely manner.
A study involving 50 suspected sick person with renal diabetes insipidus showed that the desmopressin acetate tablet test had a sensitivity of 92% and a specificity of 88%, significantly better than the traditional no water test (sensitivity of 80%, specificity of 75%).
Another study on sick person with chronic kidney disease found that sick person with Uosm<600 mOsm/kg had a threefold increased risk of renal function deterioration after medication, indicating the value of this trial in prognostic assessment.
Acute treatment of angioedema (careful assessment of risks and benefits)
Vascular edema is a disease characterized by local or systemic skin and submucosal edema, which can be divided into two categories: hereditary (C1 esterase inhibitor deficiency) and acquired (such as ACE inhibitor related). The acute phase may involve the respiratory tract, leading to a risk of suffocation.
Traditional treatment mainly involves adrenaline, glucocorticoids, and antihistamines, but some sick person may not respond well to conventional treatment. Although not a first-line drug, it may play an auxiliary role by regulating vascular permeability in specific situations.
mechanism of action
ADH can activate the V2 receptor in endothelial cells, promote the expression of aquaporin-2 (AQP2), and increase cell permeability to water. In theory, this may alleviate the exudation of vascular edema, but the evidence is limited.
Animal experiments have shown that ADH can reduce histamine induced vascular leakage, but human studies have not yet confirmed it.
Risk assessment
Exacerbation of edema:
The antidiuretic effect of ADH may lead to water retention, which may theoretically aggravate tissue edema, especially in sick person with cardiac and renal insufficiency.
Hyponatremia:
Improper dosage may cause severe hyponatremia (blood sodium<125 mmol/L), leading to seizures, coma, and even death.
Drug interactions:
Combined use with glucocorticoids, antidepressants, etc. may increase the risk of hyponatremia.
Clinical recommendations
Contraindications:
It is contraindicated for individuals with severe heart and kidney dysfunction, hyponatremia, or allergies to ADH or drug ingredients.
Cautious use scenario:
Only for short-term use under close monitoring by experienced doctors when conventional treatment is ineffective and the risk of respiratory obstruction is extremely high.
Monitoring indicators:
Blood sodium is detected every 2-4 hours during medication, with a target blood sodium decrease rate of ≤ 0.5 mmol/L/h.
A sick person with hereditary angioedema was treated with desmopressin acetate tablet for laryngeal edema. After medication, the edema temporarily improved, but severe hyponatremia and convulsions occurred 24 hours later, indicating the need to be vigilant about the risk.
Most authoritative guidelines, such as the WAO guidelines, do not recommend the use of ADH analogues for vascular edema, emphasizing their lack of evidence and high risk.
Management of polyuria in diabetes nephropathy
not the first choice of treatment, it needs to be combined with individual conditions
Diabetes nephropathy is one of the major microvascular complications of diabetes, which is manifested as glomerular hyperfiltration in the early stage and can progress to renal failure in the late stage. Polyuria (daily urine output>3L) is a common symptom, which is related to osmotic diuresis and decreased renal concentration caused by high blood sugar. Traditional management mainly focuses on controlling blood sugar and limiting drinking water, but some sick persons' symptoms are difficult to alleviate. It is possible to reduce urine output by enhancing the reabsorption of water by the kidneys, but the pros and cons need to be weighed.
Potential Applications and Limitations
ADH analogs directly act on the renal collecting duct, increasing AQP2 expression and promoting water reabsorption, thereby reducing urine output.
It has no direct effect on osmotic diuresis caused by hyperglycemia and requires combined hypoglycemic treatment.
Risks and Countermeasures
Hyponatremia:
The incidence rate is about 5% -10%, and it is more common in the elderly or those who use diuretics in combination.
Water retention:
May lead to weight gain and hypertension, so it is necessary to monitor weight and blood pressure regularly.
Drug interactions:
Combined use with SSRIs and NSAIDs may increase the risk of hyponatremia and require dose adjustment.
A study involving 30 polyuria sick person with diabetes nephropathy showed that after 4 weeks of treatment, the average urine volume decreased from 3.8L/day to 2.1L/day, and the decrease of blood sodium<2 mmol/L accounted for 80%, without serious adverse reactions.Another study suggests that the quality of life score (such as the frequency of waking up at night and thirst) significantly improves after medication, but long-term efficacy needs further verification.
Temporary diabetes insipidus after cranial surgery or pituitary injury
Craniocerebral surgery (such as pituitary tumor resection) or pituitary injury may lead to impaired synthesis or release of ADH, causing temporary diabetes insipidus, manifested as polyuria (urine volume>5L/day), restlessness, and low specific gravity urine. If left untreated, secondary dehydration, hypernatremia, and electrolyte imbalance may occur. Due to its fast onset and flexible dosage, it has become the preferred therapeutic drug.
specific application
Diagnosis and differentiation
Diagnostic criteria: Postoperative polyuria (>200ml/h for more than 2 hours), urine specific gravity<1.005, blood sodium>145 mmol/L.Differential diagnosis: It is necessary to exclude conditions such as hyperglycemic diuresis and renal diabetes insipidus. The Desmopresin test can assist in distinguishing deficient antidiuretic hormone secretions by reducing urine output by more than 50% and increasing Uosm by more than 50% after medication.
Therapeutic principle
Individualized dosage:
Adjust the dosage based on urine output, blood sodium, and body weight. The initial dose is usually 10 μ g nasal spray, once every 8-12 hours, and the maximum dose does not exceed 60 μ g/day.
Liquid management:
Supplement electrolyte solution (such as 0.45% saline) based on urine output to avoid hyponatremia caused by simply replenishing water.
Monitoring indicators:
Urine volume, blood sodium, and body weight are measured every 4-6 hours, with a target blood sodium level maintained at 135-145 mmol/L.
Treatment and Transition
Temporary diabetes insipidus:
Most patients' ADH function recovers within a few days to weeks, and medication should be gradually reduced until discontinuation.
Permanent diabetes insipidus:
If symptoms persist after 3-6 months and require long-term replacement therapy, oral desmopressin acetate tablet may be considered.
Source of information
Neurosurgery, 9th edition: Management chapter on diabetes insipidus after pituitary injury.
Pituitary Journal: Dose optimization study of Desmopresin in postoperative diabetes insipidus.
WeChat public platform (Tencent website, official website of Bo He Doctor): Clinical case sharing and expert comments.
FAQ
- What is the main clinical use of dasmopressin ethanoate?
Dasmopressin acetate is a synthetic water-regulating hormone analog. It is primarily applied to treat deficient antidiuretic hormone secretion, managing excessive urination and extreme thirst caused by insufficient endogenous water-regulating hormone. It also serves for nocturnal enuresis in children and adults, and acts as an adjuvant hemostatic agent for mild bleeding disorders.
- How does dasmopressin ethanoate exert its pharmacological effects?
This compound binds to specific receptors in the renal tubules, boosting water reabsorption and drastically reducing urine output. Compared with natural vasopressin, it features weaker vasoconstrictive activity, so it brings fewer impacts on blood pressure. Its stable chemical properties ensure sustained efficacy after administration.
- What precautions should be taken during storage and administration?
Dasmopressin ethanoate requires proper storage conditions to preserve its pharmacological potency. It should be stored in a tightly sealed container, kept away from direct light and high ambient temperatures, as exposure to these adverse conditions will cause the active ingredient to degrade and lose therapeutic activity. When administering this medication, it is essential to adhere strictly to the standard dosage guidelines provided. An excessive dose of dasmopressin acetate may trigger adverse reactions including abnormal water retention in the body and subsequent hyponatremia, a dangerous electrolyte imbalance. For this reason, patients using the drug are advised to appropriately regulate their daily water intake throughout the course of treatment to minimize related health risks.
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