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Anti-diuretic hormone (ADH, Vasopressi

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 Anti-diuretic hormone (ADH, Vasopressin):

This hormone is released by the posterior lobe pituitary along with Oxytocin.

Now this hormones secreest due to dehydration or any other problem related to this.

ADH (Vasopressin) receptors

These are G protein coupled cell membrane receptors; two subtypes V1 and V2 have been identified, cloned and structurally characterized.

Mechanism of action:

 

When ADH (Vasopressin) bind with v1 receptor they Cause contraction of blood vessels (vasoconstriction), which further decrease blood supply.

They also Cause  platelet  aggregation so also helps in blood coagulation. And when ADH (vasopressin) bind with V₂ receptor they increase the CAMP (GPCR).which further activate AQP2(Aquaprin-2) receptor through which ware transported into blood (re-absorption). They also activate Na+/K+/2Cl- Co-transporter in Loop of henle (↑ reabsorption)





Pharmacokinetics

Aqueous vasopressin (AVP) is inactive orally because it is destroyed by trypsin. It can be administered by any parenteral route or by intranasal application. The peptide chain of AVP is rapidly cleaved enzymatically in many organs, especially in liver and kidney; plasma t½ is short

~25 min. However, the action of aqueous vasopressin lasts 3–4 hours.


Uses:

A. Based on V2 actions (Desmopressin is the drug of choice):

1.   Diabetes insipidus

2.    Bedwetting in children and nocturia in adults.

3.   Renal concentration test.

4.   Haemophilia, von Willebrand’s disease.

B. Based on V1 actions

1.   Bleeding esophageal varices.

2.   Before abdominal radiography.

Adverse effects

Because of V2 selectivity, desmopressin produces fewer adverse effects than vasopressin, lypressin or terlipressin. However, transient headache and flushing are frequent. Nasal irritation, congestion, rhinitis, ulceration and epistaxis can occur on local application.

Systemic side effects are: belching, nausea, abdominal cramps, pallor, urge to defecate, backache in females (due to uterine contraction). Fluid retention and hyponatraemia may develop. Symptoms of hyponatremia are due to a shift of water intracellularly resulting in cerebral edema producing headache, mental confusion, lassitude, nausea, vomiting and even seizures. Children are more susceptible. AVP can cause bradycardia, increase cardiac afterload and precipitate angina by constricting coronary vessels. It is contraindicated in patients with ischaemic heart disease, hypertension, chronic nephritis and psychogenic polydipsia. Urticaria and other allergies are possible with any preparation.

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