deamino-arginine-vasopressin and Headache

Desmopressin acetate was recommended for nocturia in benign prostatic hyperplasia (BPH) patients recently, but its effect and safety is still controversial. We aimed to establish a systematic review and meta-analysis to confirm its effect on symptom relief and adverse effects.. A systematic search was performed in PubMed, Cochrane Library, EMBASE, Medline, Web of Science and Science Direct databases from January 2000 to October 2021 for controlled trials of BPH patients comparing oral desmopressin with control groups. The mean difference (MD) and odds ratio (OR) were meta-analyzed.. Four articles with 500 patients were included. Significantly greater benefit was detected for the desmopressin group in the improvement of nocturia (P = .004), international prostate symptom score - storage (IPSS-S) (P = .03), and quality of life (QoL) (P = .04) scores. Patients treated with desmopressin were at higher risk than the control group for short-term adverse events (P < .001), including nausea (4.71%, P = .04), headache (20%, P < .00001), dizziness (5.88%, P = .02) and hyponatremia (4.71%, P = .04), but the long-term incidence might decrease.. Desmopressin acetate can reduce nocturia frequency and improve the IPSS-S and QoL score in BPH patients. Some adverse reactions of desmopressin, such as hyponatremia, headache, dizziness and nausea, may be mild and short-term. No significant difference of desmopressin was found in improving the overall IPSS score and maximum urine flow.

Topics: Deamino Arginine Vasopressin; Dizziness; Headache; Humans; Hyponatremia; Male; Nausea; Nocturia; Prostatic Hyperplasia; Quality of Life; Treatment Outcome

The optimal management of menorrhagia among women with abnormal laboratory haemostasis is uncertain. In a crossover study, 116 women with menorrhagia [pictorial blood assessment chart (PBAC) score >100], negative gynaecological evaluation and abnormal laboratory haemostasis were randomly assigned to either intranasal desmopressin (IN-DDAVP) or tranexamic acid (TA) therapy for two menstrual cycles. The subjects then crossed over to the second study drug for two additional cycles. Menstrual blood loss (MBL) was measured by PBAC scores at baseline and after each menstrual cycle. Quality of life (QOL) was assessed with four validated instruments. There was a statistically significant decrease in PBAC scores for both treatments. On average, the estimated decrease in the PBAC from baseline was -64.1 [95% confidence interval (CI) = -88.0, -40.3] for IN-DDAVP and -105.7 (95% CI = -130.5, -81.0) for TA. The decrease in PBAC score was greater for TA than IN-DDAVP (a difference of 41.6, P-value = 0.0002, 95% CI = 19.6, 63.6). The test for treatment-type effect was significant (P < 0.0001) suggesting a greater reduction in PBAC score with TA. Use of both IN-DDAVP and TA improved QOL by all four instruments. We conclude that both medications reduced MBL and improved QOL among females with menorrhagia and abnormal laboratory haemostasis, but TA proved more effective.

Topics: Administration, Intranasal; Administration, Oral; Adult; Antifibrinolytic Agents; Cross-Over Studies; Deamino Arginine Vasopressin; Female; Headache; Hemostatics; Humans; Menorrhagia; Prospective Studies; Quality of Life; Tranexamic Acid

Air operations may demand missions of many hours, and aircrew may experience significant discomfort due to bladder distension. Attention has been given to the use of in-flight urination devices, but an alternative strategy could be reduction of urine flow by an anti-diuretic. In this event it would be important to establish an effective dose range free of adverse effects.. The effects of desmopressin (0.05, 0.10, 0.15, and 0.20 mg) on cognitive performance and sleepiness (multiple sleep latency test) from 1 to 11 h, and on urine flow up to 24 h after drug ingestion at 09:00, were studied in 20 healthy young volunteers. The study was double blind, placebo controlled, and with a randomized five-way crossover design.. There was no evidence of impaired performance with desmopressin at or below 0.15 mg. All doses reduced urine flow up to 12 h after drug ingestion (p < 0.001), and the reduction appeared to be maximal at 0.10 mg. The dose range was free of adverse effects, except for the possibility of headaches, but they are unlikely to be of operational significance.. Desmopressin could prove to be a significant advance in the management of urinary flow in operational aircrew. The dose could be as low as 0.05 mg with the option to use 0.10 mg in those less sensitive to the drug. Individual experience of the effect of the drug would be appropriate before use in flight, and guidelines concerning fluid intake would be needed. Further information may be required for use of the drug overnight.

Topics: Adult; Aerospace Medicine; Aircraft; Cognition; Cross-Over Studies; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Double-Blind Method; Female; Headache; Humans; Male; Placebos; Renal Agents; Sleep; Urodynamics

The purpose of this study was to investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in women.. Women aged 18 years or older with nocturia (>or=2 voids per night with a nocturia index score >1) received desmopressin (0.1 mg, 0.2 mg, or 0.4 mg) during a 3-week dose-titration period. After a 1-week washout period, patients who responded in this period received desmopressin or placebo in a double-blind fashion for 3 weeks.. In double-blind phase, 144 patients were randomly assigned to groups (desmopressin, n=72; placebo, n=72). For desmopressin, 33 (46%) patients had a 50% or greater reduction in nocturnal voids against baseline levels compared with 5 (7%) patients receiving placebo (P<.0001). The mean number of nocturnal voids, duration of sleep until the first nocturnal void, nocturnal diuresis, and ratios of nocturnal per 24 hours and nocturnal per daytime urine volumes changed significantly in favor of desmopressin versus placebo (P<.0001). In the dose-titration phase headache (22%), nausea (8%), and hyponatremia (6%) were reported. Two deaths occurred, although neither could be directly associated with the study drug.. Oral desmopressin is an effective and well-tolerated treatment for nocturia in women.

Topics: Adult; Aged; Deamino Arginine Vasopressin; Double-Blind Method; Female; Headache; Humans; Hyponatremia; Middle Aged; Nausea; Renal Agents; Urination Disorders

The objective of this study was to investigate the efficacy and safety of desmopressin (1-desamino-8-D-arginine vasopressin) compared with placebo in the reduction of menstrual blood loss in women with menorrhagia and prolonged bleeding time, but without common coagulation factor deficiencies. We performed a randomized, double-blind, cross-over study using 300 microg desmopressin nasal inhalation or placebo treatment in one of the two first treatment cycles. Desmopressin was given only for the 2 days during which the bleeding had been at a maximum in the previous baseline cycle. A third open cycle involved combined treatment with desmopressin and tranexamic acid during the 2 days for all patients. Menstrual blood loss during the treatment periods was compared with blood loss during placebo-treated periods using objective measurement. A significant reduction of menstrual blood loss was found in the cycles treated with combined desmopressin and tranexamic acid compared with placebo. When analyzing the blood loss during the two treatment days, there was a significant reduction in blood loss for the 2 days with desmopressin alone versus placebo. The treatment was well tolerated and no serious adverse events were recorded. In conclusion, we find that nasal desmopressin is a possible complement for the medical treatment of menorrhagia.

Topics: Adult; Bleeding Time; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Female; Flushing; Headache; Hemorrhagic Disorders; Hemostatics; Humans; Menorrhagia; Nausea; Tranexamic Acid; Treatment Outcome

We report our experience with the incidence of adverse events during the use of Stimate brand intranasal desmopressin acetate (IN DDAVP) for patients with haemophilia A (HA) or von Willebrand disease (vWD) after noting two severe adverse events in one adult patient. All patients with documented vWD (type 1 or 2 A) or haemophilia A (mild, moderate or symptomatic carrier) from the Emory Comprehensive Hemophilia Center who had IN DDAVP challenge testing or were using Stimate for treatment of bleeding were evaluated for adverse events by patient report or nursing observation of clinical signs and symptoms. Forty patients were studied. Sixty-eight per cent (27/40) experienced clinical signs and/or symptoms. The majority of these symptoms were mild, however several patients reported moderate to severe side-effects and one adult patient required medical intervention for symptomatic hyponatraemia. In our experience, two-thirds of patients tested experienced adverse signs and/or symptoms with the use of Stimate; considerably higher than that reported from preliminary results in the literature. Young age did not correlate positively with adverse reactions. Severe adverse events requiring medical intervention were rare, however symptoms such as moderate to severe headache, nausea, vomiting and weakness may necessitate evaluation for hyponatraemia. This is the first report of symptomatic hyponatraemia in an adult patient with recommended dosing of Stimate. Side-effects may be minimized if patients adhere to instructions regarding fluid intake and composition while using IN DDAVP.

Topics: Administration, Intranasal; Adolescent; Adult; Age Factors; Child; Child, Preschool; Deamino Arginine Vasopressin; Fatigue; Female; Headache; Hemophilia A; Hemostatics; Heterozygote; Humans; Hyponatremia; Male; Menorrhagia; Middle Aged; Nausea; Potassium; Sex Factors; Sodium; von Willebrand Diseases; Weight Gain

Topics: Arginine Vasopressin; Clinical Trials as Topic; Deamino Arginine Vasopressin; Double-Blind Method; Headache; Humans; Spinal Puncture

In a double-blind controlled trial the possible prophylactic effect of intranasally applicated DDAVP (1-desamino-8-arginine vasopressin, Minurin)--a synthetic analogue of vasopressin--is evaluated regarding the incidence of headache following lumbar puncture (LBP) in 51 patients and following pneumoencephalography (PEG) in 28 patients. DDAVP had no statistically significant effect on the incidence of headache or on the consumption of analgesics in the DDAVP-versus placebo groups (minimal relevant difference = 50%, 2 alpha = 0.05, beta = 0.50).

Topics: Adult; Aged; Arginine Vasopressin; Deamino Arginine Vasopressin; Double-Blind Method; Female; Headache; Humans; Male; Middle Aged; Placebos; Pneumoencephalography; Spinal Puncture

Symptomatic metastases to the pituitary (MP) from renal cell carcinoma (RCC) are rare. In this largest case series reported, we describe the clinical features, treatment and outcome of 5 patients. Over a 6-year period (2000-2006), we treated 5 patients (3 males; mean age 61 years) with large sellar masses and RCC. Four patients had a history of RCC, while in one, RCC was diagnosed after surgery. RCC was diagnosed a median of 11 years prior to diagnosis of MP (range 0-27 years). Four patients had previously developed distant metastases. Clinical presentation included bitemporal hemianopia (3 patients), lethargy (3), headaches (2) and diabetes insipidus (DI) (2). Panhypopituitarism was present in 3 patients and the other two had deficiency of at least ACTH and gonadotropin axes. Elevated prolactin was seen in 3 patients. MRI showed an enhancing sellar mass with suprasellar extension and chiasmal compression in all; prominent vascular flow voids were seen in 2. Three patients underwent transsphenoidal surgery and radiation, while 2 underwent radiotherapy alone. Four patients are alive (follow up 6-46 months); 1 patient died due to systemic metastases at 12 months. Metastases to the pituitary from RCC cause more severe hypopituitarism and visual dysfunction compared to those from other primaries, whereas DI is less common. MRI shows contrast enhancement, stalk involvement, sclerosis and/or erosion of sella and presence of vascular flow voids. Combined treatment using decompressive surgery and stereotactic radiotherapy may result in better outcomes.

Topics: Aged; Carcinoma, Renal Cell; Combined Modality Therapy; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Headache; Hemianopsia; Hormones; Humans; Hydrocortisone; Kidney Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Nephrectomy; Pituitary Neoplasms; Thyroxine; Treatment Outcome

We present the eldest case ever reported of central diabetes insipidus (DI) associated with infundibulo-neurohypophysitis. A 77-year old woman, who complained of recent development of excessive thirst, polyuria and polydipsia, was referred to our hospital. The daily urine volume was markedly increased to 6 L. DDAVP administration effectively reduced urine volume and increased urine osmolality. The loading test using high-osmolar sodium chloride showed impaired excretion of vasopressin discordant with plasma osmolar changes. The anterior pituitary function was normal. Pituitary magnetic resonance imaging (MRI) showed thickening of the pituitary stalk and a lack of high-intensity signal of the neurohypophysis on T1-weighted images, suggestive of lymphocytic infundibulo-neurohypophysitis. The thickness of pituitary stalk on MRI improved 6 months later. DI was controlled with DDAVP for 40 days. This was followed by stabilization of the daily urine volume to less than 2.5 L without DDAVP. Our case is the eldest case of central DI associated with infundibulo-neurohypophysitis. The rapid remission of pituitary changes on MRI provides an insight that spontaneously partial remission of central DI may occur, resulting in transient polyuria and polydipsia.

Topics: Aged; Blood; Chlorides; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Headache; Humans; Lymphocytes; Magnetic Resonance Imaging; Osmolar Concentration; Pituitary Diseases; Pituitary Gland, Posterior; Potassium; Sodium; Thirst; Urine; Vasopressins

Topics: Adult; Blood Glucose; Brain Edema; Brain Neoplasms; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus, Type 1; Diabetic Coma; Diabetic Ketoacidosis; Diagnosis, Differential; Fatal Outcome; Female; Fluid Therapy; Headache; Humans; Hypernatremia; Insulin; Polyuria; Postoperative Complications; Radiography

We studied the differential increase in FVIIIc and FVIII R:Ag after the intravenous infusion of 0.30 micrograms/kg DDAVP in 20 obligate hemophilia A carriers and in 20 female controls. FVIIIc increased in carriers (59.5 +/- 23.1 to 137.5 +/- 45.9) and in controls (98.0 +/- 20.7 to 259.9 +/- 57.4) (P less than 0.001), but the magnitude of the FVIIIc increase in carriers was less than that in controls by 51.9% (P less than 0.001). FVIII R:Ag increased comparably in carriers (105.2 +/- 30.4 to 171.9 +/- 25.4) and controls (92.1 +/- 33.0 to 165.2 +/- 20.6). Using the post-DDAVP instead of the standard FVIIIc/FVIII R:Ag ratio, hemophilia carrier detection was increased from 85% (with 10% false positive and 20% false negative assignments) to 95% (with 5% false positive and 5% false negative assignments). Toxicity associated with DDAVP infusion correlated linearly with doses greater than 10.5 +/- 1.3 micrograms/m2 (P less than 0.02) and with total doses greater than 17.0 +/- 4.5 micrograms (P less than 0.02). The use of DDAVP improves carrier detection in factor VIII-deficient hemophilia.

Topics: Adolescent; Adult; Analysis of Variance; Antigens; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Drug Evaluation; Factor VIII; False Negative Reactions; False Positive Reactions; Female; Genetic Carrier Screening; Headache; Hemophilia A; Humans; Male; Middle Aged; von Willebrand Factor

Topics: Child; Craniopharyngioma; Deamino Arginine Vasopressin; Diabetes Insipidus; Headache; Humans; Male; Pituitary Neoplasms; Postoperative Complications; Vision Disorders

Topics: Deamino Arginine Vasopressin; Headache; Humans; Plasminogen Activators; Spinal Puncture

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Headache; Humans; Spinal Puncture

Topics: Deamino Arginine Vasopressin; Headache; Humans; Injections, Intramuscular; Spinal Puncture