deamino-arginine-vasopressin and Drug-Hypersensitivity

Any therapy must have a benefit and a risk. The benefit of aprotinin therapy in reducing bleeding is well known. Data presented over the past 12 months have confirmed this efficacy and the superiority and consistency of aprotinin therapy in direct comparison with other pharmacologic (desmopressin, tranexamic acid) and physical (administration of fresh platelet concentrate) interventions. The debate has now changed to focus on issues of the safety of this agent. In particular, concerns have been expressed as to the effect of this agent on renal function, thrombotic potential (and thus graft patency), and adverse reactions on a second exposure. Most recent reports show plasma creatinine concentrations are higher in treated than in nontreated patients on the 3rd or 4th postoperative day. The concentrations reached were not outside the clinical range, and there were no clinical sequelae of this biochemical abnormality. Focused studies have shown no effect of the use of aprotinin therapy on early graft patency or the incidence of thromboembolic complications. The reporting of hypersensitivity reactions following aprotinin administration suggests that the incidence is not different to other agents used in open heart surgery. Three reports of fatal or near-fatal cardiovascular collapse associated with the use of aprotinin followed the apparently inappropriate administration of the agent.

Topics: Aprotinin; Coronary Artery Bypass; Creatinine; Deamino Arginine Vasopressin; Drug Hypersensitivity; Hemostasis, Surgical; Hemostatics; Humans; Kidney; Platelet Transfusion; Safety; Thrombosis; Tranexamic Acid; Vascular Patency

Von Willebrand's disease is categorized into types and subtypes based on multimeric analysis of plasma von Willebrand's factor. Such categorization is of value because both the mode of inheritance and the choice of therapeutic material differ between subtypes. The Type IIB variant is characterized by hypersensitivity in vitro to ristocetin and thrombocytopenia after administration of desmopressin (DDAVP). Hypersensitivity to ristocetin has also been described in Type I variants but without thrombocytopenia after DDAVP. This report describes a new Type II variant characterized by the converse situation, absence of hypersensitivity to ristocetin in vitro but transient thrombocytopenia after intravenous administration of DDAVP.

Topics: Deamino Arginine Vasopressin; Drug Hypersensitivity; Female; Humans; Infusions, Intravenous; Male; Pedigree; Platelet Aggregation; Platelet Count; Ristocetin; Thrombocytopenia; von Willebrand Diseases; von Willebrand Factor

The antivasopressor analog d(CH2)5Tyr(Me) arginine-vasopressin completely blocked the convulsive-like behavior and other severe motor disturbances which are normally observed following a second central arginine-vasopressin injection. This vasopressor antagonist appears to be selective for arginine-vasopressin-induced motor disturbances, in that the convulsive and motor effects of pentylenetetrazol and somatostatin were not altered significantly by pretreatment with the central antagonist. Results suggest that arginine-vasopressin-induced motor disturbances are mediated via central receptors. The classic antidiuretic (V2) type of arginine-vasopressin receptor does not appear to be involved, since the agonist 1-desamino-8-D-arginine-vasopressin did not elicit convulsive-like behavior or other severe motor disturbances 2 days following a first ('priming') injection of arginine-vasopressin.

Topics: Animals; Arginine Vasopressin; Brain Diseases; Deamino Arginine Vasopressin; Drug Hypersensitivity; Male; Movement Disorders; Pentylenetetrazole; Rats; Rats, Inbred Strains; Somatostatin; Vasoconstrictor Agents

Topics: Adult; Alveolitis, Extrinsic Allergic; Arginine Vasopressin; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Hypersensitivity; Humans; Male; Pituitary Gland, Posterior; Tissue Extracts

Topics: Arginine Vasopressin; Chlorobutanol; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Hypersensitivity; Female; Humans; Middle Aged; Pruritus; Solutions

Topics: Administration, Intranasal; Adult; Arginine Vasopressin; Asthma; Deamino Arginine Vasopressin; Diabetes Insipidus; Drug Hypersensitivity; Humans; Male; Pulmonary Fibrosis; Vasopressins