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[Long-term treatment of central diabetes insipidus with oral DDAVP]
Abstract:
Clinical use of the DDAVP (1-Deamino-8-D-Arginine Vasopressin) is now the first choice in treatment of Central Diabetes Insipidus. It is an analogue of Vasopressin with a higher antidiuretic potency, less vasopressor activity, and a longer duration of action. This drug still presents some problems of administration route. A lot of studies were published about different administration routes of DDAVP: sublingual tablets, parenteral solution, nose spray and suction de-epithelialized skin. Some authors have utilized the oral route (solution or tablets) with good results in short-term treatment. We think the formulation in tablets of DDAVP is an efficacious support of the therapy in this disease also for long-treatment. In our study 3 patients with Central Diabetes Insipidus (aged 22-56; 2 idiopathic and 1 post-surgery) previously treated with DDAVP nasal solution (10 micrograms/day; 36-156 months), have been submitted to a chronic treatment with DDAVP tablets for a period of 24-36 months. The DDAVP tables were administered at the dosage of 400-600 micrograms/day in 2-3 administrations. The patients were studied at intervals of 3-6 months, and on each occasion full blood count, glucose, azotaemia, creatinine, liver function tests, electrolytes, urine volume, density and osmolality were estimated. The long-treatment with oral DDAVP was able to keep a good control of the disease in all patients. In case 1 we had a significant reduction of urine volume (p < 0.01) and a significant increase (p < 0.01) of urine osmolality in comparison with previous treatment with nasal solution; in case 2 and 3 no significant changes were observed. No side effects were noted during this study. The drug has been well tolerated and the compliance of patients was better during oral DDAVP than nasal solution. In our opinion the oral DDAVP is an effective and safe solution for the treatment of Central Diabetes Insipidus, and give to the patients a better quality of life in comparison to the nasal solution.