Pharmacological properties of the drug Minirin
Minirin tablets contain desmopressin - a synthetic analogue of the natural hormone of the posterior lobe of the pituitary gland - arginine vasopressin (antidiuretic hormone). Desmopressin was obtained as a result of changes in the structure of the vasopressin molecule: deamination of 1-cysteine and replacement of 8-L-arginine with 8-D-arginine. Compared with vasopressin, desmopressin has a minor effect on vascular smooth muscle with more pronounced antidiuretic activity. Thanks to the described structural changes, Minirin activates only V2 vasopressin receptors located in the epithelium of the convoluted tubules and a wide part of the ascending loops of Henle, which causes an expansion of the pores of nephron epithelial cells and leads to increased reabsorption of water into the bloodstream. After taking the drug, the antidiuretic effect occurs within 15 minutes. Taking 0.1–0.2 mg of desmopressin provides an antidiuretic effect lasting up to 8–12 hours in most patients. The use of Minirin in patients with an established diagnosis of diabetes insipidus of central origin leads to a decrease in the volume of urine excreted and a concomitant increase in its osmolarity. As a result, the frequency and severity of nocturia decreases. No teratogenic or mutagenic effects of desmopressin have been identified. Desmopressin begins to be detected in the blood 15–30 minutes after administration. The maximum concentration in the blood plasma is reached after 2 hours. The half-life of desmopressin in the blood plasma is 1.5–3.5 hours. The drug is excreted in the urine, partly unchanged, partly after enzymatic breakdown.
MINIRIN (tablets)
steals and helps.
Previously, people with diabetes insipidus were given it free of charge. Now, as far as I know, they have switched to some Russian analogue, which everyone is complaining about. If you want it for free, take what they give you. If you want Minirin, pay out of your own pocket. And it costs very much. It turns out to be expensive because it is needed every day, sometimes several times. But here it depends. The fact is that the dosage for it is selected individually. That is, even an adult can sometimes benefit from a minimum dose, but a child may need a maximum. And so on until the end of my life. In our family, a dog suffers from this disease. At the age of 11, I suddenly began drinking five liters a day like crazy and peeing at home. At the same time, sugar was normal, as were other blood parameters. To diagnose diabetes insipidus, both people and animals need to undergo two urine tests. One is normal, and the second is after abstaining from drinking for about 10 hours. If in the second analysis the density of urine does not increase, a diagnosis is made immediately, since such symptoms do not occur with any other diseases. Since then we have been drinking Minirin.
Naturally we were unlucky. Low doses had no effect on us. We need the maximum dose as many times a day as possible. At the moment it comes out to about 5500 per month. The dose of Minirin is set approximately as follows. We take the minimum number of tablets for 7-10 days. If thirst does not go away or the amount of water drunk exceeds 3 liters per person (dogs have their own norms), then the dose is increased and they wait another 7-10 days. And so on until the maximum possible indicator. As a rule, it does not happen that a person needs more than what is allowed according to the instructions. It's the same with dogs.
Determining the dose in an animal is much more complicated. They cannot talk about their feelings. You have to focus solely on how much the dog drinks. Moreover, it is necessary to allow the hormone to accumulate a little in the body. It is impossible, for example, if the tablet did not work after a couple of days, immediately increase the dose. It can begin to fully satisfy the body's needs only after a few more days. If you immediately increase the dose, then lowering it later will not work. The body will get used to more of the hormone and will no longer agree to less. Once you fail to show patience, you will have to pay much more for the rest of your life than you could. In addition, the higher the dose, the more likely side effects are, which manifest themselves in the form of dizziness, abdominal pain, headache, nausea, allergies, dry mouth and pain when urinating. This was probably our mistake. It was impossible not to give the dog anything to drink due to the possibility of dehydration. But at the same time she continued to write at home. We didn’t even have time to take her out into the yard. Therefore, they were probably in a hurry when selecting the dose. The most interesting thing is that even the maximum possible dose did not completely help after a week. Everything was fully restored a little later. Therefore, take your time, otherwise you will have to work for this Minirin all your life, and the dog will silently suffer from side effects that it will not even be able to talk about.
It is much easier for people also because they can control the effect of the drug, listen to their feelings and understand what is happening to them at one time or another. They can feel when Minirin is urgently needed, and when they can and will skip the dose. Thus, you can take pills not at a time, but only when the body needs it. This allows you to save a little. It also allows you to reduce the amount of the required dose and certain methods of using Minirin, which, unfortunately, are also available only to people. For example, some people do not swallow the tablet, but hold it under their tongue, gradually dissolving it. In this case, the absorption of the medicine is much more efficient than through the stomach and its action lasts for a longer time. Minirin also penetrates the blood faster if it is crushed and inhaled through the nose. Some people take a whole tablet at night and only half in the morning. For dogs, there is only one way to improve absorption. This means giving the tablet without food. I usually give it two hours before or after meals. It's almost impossible to miss. As soon as you forget to give a pill, there’s a puddle on the floor. The dog is old and can't do anything about it. Therefore, you have to set alarms and live almost by the clock.
In general, as far as I understood from reading people’s reviews about Minirin, its effect is felt immediately after the first tablet. It is certainly not sufficient, but it becomes easier immediately. And for two years now he has been helping us faithfully. There is no addiction, and the condition is still worsening. When we were prescribed medication, our veterinarian asked which medication to prescribe would be cheaper or better. We said that we need the best. There is nowhere to go, the dog has been living with us for a long time, and somehow we don’t dare give her obviously bad medications. Therefore, it may not be the best medicine for diabetes insipidus, but it is certainly one of the best.
Use of the drug Minirin
Use the drug only as prescribed by a doctor. The optimal dose of the drug is selected individually. Diabetes insipidus . The initial dose for adults and children over 5 years of age is 0.1 mg desmopressin 3 times a day. The further dose is selected depending on the reaction of the patient’s body. Based on the results of clinical experience, the daily dose varies from 0.2 to 1.2 mg of desmopressin. For most patients, the optimal dose is 0.1–0.2 mg desmopressin 3 times a day. Primary nocturnal enuresis . The starting dose for adults and children over 5 years of age is 0.1 mg desmopressin at night. In case of insufficient effect, the dose may be increased to 0.4 mg. The course of treatment is 3 months. The question of the need to continue therapy should be decided after a week's break while taking Minirin. During therapy, fluid intake should be limited at night and after taking the drug. Nocturia (nocturnal polyuria). The starting dose recommended for adults and children over 5 years of age is 0.1 mg at night. If the initial dose is ineffective within 1 week, then gradually increase the dose weekly to 0.2 mg and subsequently to 0.4 mg. You should be wary of fluid retention in the body. In patients 65 years of age and older, blood sodium levels should be monitored before starting treatment, after 3 doses of the drug, and after increasing the dose. If symptoms of fluid retention and/or hyponatremia develop (headache, nausea, vomiting, weight gain, and in severe cases, convulsions), treatment should be stopped immediately until the patient recovers completely. When restarting treatment, the patient's fluid intake should be monitored more closely.
Special instructions for the use of the drug Minirin
The use of the drug in patients with an established diagnosis of diabetes insipidus leads to a decrease in the volume of urine excreted and an increase in its osmolarity, resulting in a decrease in the frequency of urination. Considering the possible risk of fluid retention in the body, the drug Minirin should be used with extreme caution in early childhood and old age; in conditions accompanied by water or electrolyte imbalance; in patients at risk of increased intracranial pressure; during pregnancy. During therapy with Minirin, the volume of urine excreted should be monitored and laboratory tests should be used to determine the osmolarity of urine; in some cases, it is necessary to determine the osmolarity of the blood plasma. In the treatment of nocturnal enuresis, fluid intake should be limited to a minimum - only to quench thirst; This regimen is established 1 hour before taking the drug Minirin and for 8 hours after that. During pregnancy and breastfeeding. In studies of the effect of the drug Minirin on reproductive function conducted on animals, the absence of undesirable effects on the fetus was established. When analyzing a sufficiently large number of cases of use of the drug by pregnant women, there was no evidence of an increase in the incidence of malformations in newborns. Based on the results of the analysis of breast milk of mothers receiving desmopressin in high doses (300 mcg intranasally), it was shown that the amount of desmopressin that can be transferred to the child is significantly less than the amount of the drug that affects diuresis.
Minirin®
To avoid the development of side effects, it is imperative to limit fluid intake to a minimum 1 hour before use and for 8 hours after use of the drug in patients with primary nocturnal enuresis. Failure to comply with the rules for taking the drug can cause fluid retention in the body and/or hyponatremia, which can be manifested by the following symptoms: headache, dizziness, nausea, vomiting, weight gain, in severe cases - cerebral edema, convulsions and coma. The safety of the drug during long-term use in cases of nocturnal enuresis has not been studied.
Cases of cerebral edema and seizures have been reported in healthy children and adolescents when desmopressin was taken to treat nocturnal enuresis. Based on the available information, we can conclude that the risk of developing cerebral edema and seizures is highest in the first week of taking the drug.
Hyponatremia most often occurs in elderly patients (over 65 years of age) and in patients with initially low sodium concentrations.
The duration of action of the drug increases with increasing dose, leading to an increased risk of developing hyponatremia. Increasing the dose should be done with great caution.
The drug Minirin® should be used with caution in patients with chronic renal failure, bladder fibrosis, cystic fibrosis, coronary heart disease, arterial hypertension, with a potential risk of increased intracranial pressure: water-electrolyte imbalance; in patients at risk of developing thrombosis; during pregnancy, including preeclampsia; in elderly patients (over 65 years old). Before starting the drug (and 3 days after starting or increasing the dose), patients over 65 years of age must determine the sodium content in the blood plasma. If headache and/or nausea occurs, the drug should be discontinued.
Patients with arterial hypertension or chronic kidney disease may develop the symptoms listed in the “Side Effects” section. Particular caution should be exercised when using Minirin® in children and elderly patients, or patients at risk of increased intracranial pressure, trying to prevent fluid retention in the body.
Violation of the drug regimen can cause fluid retention in the body and the development of hyponatremia.
Patients and, when using the drug in children, their parents should be informed about the need to limit fluid intake and to stop taking desmopressin in case of vomiting, diarrhea, systemic infectious diseases and fever, and not to resume taking it until the water-electrolyte balance is normalized.
To reduce the risk of developing hyponatremia or fluid retention, reduce fluid intake in the following cases:
- when taking medications that lead to the syndrome of inadequate production of antidiuretic hormone (tricyclic antidepressants, selective serotonin reuptake inhibitors, chlorpromazine, chlorpropamide and carbamazepine);
- with concomitant use of PPVPs.
During treatment, changes in body weight should be monitored.
Before using the drug, organic causes of polyuria, increased urine volume or nocturia should be excluded, including prostatic hyperplasia, urinary tract infections, nephrolithiasis, bladder tumors, bladder sphincter dysfunction, polydipsia or impaired glycemic control in diabetes mellitus, and in the presence of the above diseases carry out appropriate treatment.
Before starting treatment, it is necessary to treat insufficiency of the adrenal cortex or thyroid gland.
Patients with rare hereditary diseases, including galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome, should not take Minirin®.
Overdose of the drug Minirin, symptoms and treatment
Overdose increases the risk of hyponatremia and fluid retention in the body. Although treatment for hyponatremia must be individualized, there are general recommendations:
- in case of asymptomatic hyponatremia, treatment with Minirin should not be interrupted and the patient’s fluid intake should be further limited;
- in case of symptoms caused by hyponatremia, an iso- or hypertonic solution of sodium chloride should be administered intravenously;
- in severe cases of fluid retention in the body, manifested by convulsions and/or loss of consciousness, furosemide should be included in complex (symptomatic) therapy.
