데스모프레신

호르몬제 - 합성 바소프레신 유사체

**데스모프레신(DDAVP)**은 천연 뇌하수체 항이뇨 호르몬인 아르기닌 바소프레신의 합성 유사체입니다. 구조적으로 변형되어 혈압 상승 작용은 거의 제거된 반면 항이뇨 특성은 크게 강화되었습니다. 수의학에서는 주로 두 가지 임상 목적으로 사용됩니다: * **중추성 요붕증(CDI):** 개와 고양이의 CDI 진단(반응 시험을 통해) 및 장기 관리를 위한 표준 치료제로, 심각한 다뇨 및 다음 증상을 효과적으로 해결합니다. * **폰 빌레브란트병(vWD):** 특정 하위 유형의 vWD 환자에서 수술 전후 혈액 응고 인자를 일시적으로 높이기 위해 사용되지만, 작용 시간이 짧고 내성(빠른 내약성)이 빨리 발생하여 장기적인 유용성은 제한적입니다. **임상 요점:** 동물에서 경구 생체이용률이 매우 낮기 때문에, 수의학 환자에서는 인체용 비강 스프레이를 **결막낭(눈)에 국소적으로 점안**하는 방식이 가장 흔하게 사용되며, 이는 신뢰할 수 있고 비침습적인 흡수 경로를 제공합니다.

작용 기전: Desmopressin exerts its effects through two primary mechanisms based on its high affinity for specific receptors: * **Antidiuretic Action (Kidneys):** Desmopressin selectively binds to **V2 receptors** on the basolateral membrane of cells in the renal distal tubules and collecting ducts. This binding activates adenylate cyclase → increases intracellular cAMP → triggers the translocation and insertion of **aquaporin-2 (AQP2)** water channels into the apical membrane. This dramatically increases water permeability, allowing water to be reabsorbed passively back into the bloodstream, thereby concentrating the urine and reducing urine volume. * **Hemostatic Action (Endothelium):** Desmopressin binds to **V2 receptors** on vascular endothelial cells → stimulates the rapid exocytosis of Weibel-Palade bodies → releases stored **von Willebrand factor (vWF)** and **Factor VIII** into the plasma. It also increases plasminogen factor levels.

동물 종별 용량

Cats

Differentiate central diabetes insipidus from nephrogenic form · 1 drop into the conjunctival sac · topical · twice daily · 2-3 days · Dramatic reduction in water intake or >=50% increase in urine concentration gives strong evidence for ADH deficit.
Central diabetes insipidus · 1-2 drops into the conjunctival sac · topical · once or twice a day · Duration of activity is 8-24 hours.
Central diabetes insipidus · 1- 4 drops of the intranasal solution in the conjunctival sac · topical · once to twice daily
Central diabetes insipidus · 2-5 micrograms · SC · once to twice daily · Using intranasal solution parenterally.
Central diabetes insipidus (oral alternative) · 25-50 micrograms (total dose; 1/4th to 1/2 of a 100 microgram tablet) · PO · q12h · Dose and response may be variable.

Horses

Diagnosis of diabetes insipidus · 20 micrograms · IV · Once
Diagnosis of diabetes insipidus · 0.05 micrograms/kg · IV · Once · Dilute the nasal spray formulation (0.1 mg/ml) in sterile water. Measure USG every 2 hours. Increase to >=1.025 within 2-7 hours is consistent with central DI.

Dogs

Central diabetes insipidus · One drop placed in the conjunctival sac · topical · twice daily (or three times a day) · Using one drop three times a day usually returns urine production to normal.

투여 경로

topical (conjunctival)SCIVPOintranasalIntranasalIM

금기

Hypersensitivity to desmopressin
Type IIB or platelet-type (pseudo) Von Willebrand's disease (may cause platelet aggregation and thrombocytopenia; notably seen in German Shorthair Pointers)
Hyponatraemia (specifically for modified water deprivation test)
Renal disease (specifically for modified water deprivation test)
Dehydration (specifically for modified water deprivation test)
Hypercalcaemia (specifically for modified water deprivation test)

이상반응

Eye irritation (following conjunctival administration)
Hypersensitivity reactions
Fluid retention (with overdosage)
Hyponatremia (with overdosage)
Headache (reported in humans)

약물 상호작용

Chlorpropamide · May enhance the antidiuretic effects of desmopressin
Fludrocortisone · May enhance the antidiuretic effects of desmopressin
Urea · May enhance the antidiuretic effects of desmopressin

모니터링

Serum electrolytes (especially sodium)
Urine osmolality and/or urine volume
Bleeding times (when used for Von Willebrand's disease)
Adrenocortical function (prior to water deprivation test)
Serum sodium (Clinical Pearl)
Urine specific gravity (Clinical Pearl)
Bleeding times/vWF levels if used for bleeding disorders (Clinical Pearl)

과용량

Chronic oral doses of 0.2 mg/kg/day have been given to dogs for 6 months without significant toxicity. However, acute or severe overdosage may lead to **fluid retention** and **hyponatremia** (water intoxication). > **Treatment:** Employ dosage reduction and strict fluid restriction. Monitor serum electrolytes (especially sodium) closely to prevent neurological complications associated with hyponatremia.

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