Desmopressin (DDAVP)
Overview
A synthetic analog of vasopressin with enhanced V2 receptor selectivity and minimal V1a vasopressor activity. Desmopressin has a deaminated cysteine at position 1 and D-arginine at position 8, increasing its antidiuretic potency 10-fold while largely eliminating the hypertensive effects of native vasopressin. Its prolonged half-life of 2-4 hours (vs. 10-20 minutes for vasopressin) allows convenient dosing for chronic conditions.
Key Research Findings
FDA-approved for central diabetes insipidus, primary nocturnal enuresis, hemophilia A, and von Willebrand disease (type 1). Releases stored von Willebrand factor and factor VIII from endothelial Weibel-Palade bodies. DDAVP challenge test used to assess coagulation factor response pre-procedurally. Risk of hyponatremia with fluid overloading requires careful monitoring, especially in elderly patients.
Intranasal, Oral, Subcutaneous injection, Intravenous
FDA Approved
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Vasopressin (ADH)
FDA ApprovedA nine-amino acid cyclic peptide hormone (arginine vasopressin) produced in the hypothalamus and released from the posterior pituitary. Vasopressin acts on V1a receptors (vascular smooth muscle vasoconstriction), V1b receptors (ACTH release from pituitary), and V2 receptors (aquaporin-2 insertion in renal collecting ducts for water reabsorption). It is essential for body water homeostasis and hemodynamic stability.
Terlipressin
FDA ApprovedA synthetic vasopressin analog and prodrug that is cleaved by endopeptidases to release lysine-vasopressin. Terlipressin has greater V1a receptor selectivity than vasopressin, producing splanchnic vasoconstriction that reduces portal pressure and redistributes blood flow to the kidneys. This mechanism addresses the pathophysiology of hepatorenal syndrome (HRS) by counteracting the splanchnic vasodilation that drives renal hypoperfusion.