Treatment of Renal Colic by Desmopressin Intranasal Spray and Diclofenac Sodium

Abstract

The vasopressin analogue, 1-desamino-8-arginine vasopressin (desmopressin), is a potent antidiuretic without the pressor effects of vasopressin. A total of 18 patients with acute renal colic due to stone disease received 40 microgramsf1p4mopressin intranasal spray with encouraging results. There was a significant decrease in the colic pain intensity from an initial mean visual analogue score of 67 +/- 17 mm. to 39 +/- 36 mm. within 30 minutes (p < 0.001). Eight patients (44.4%) had complete pain relief within 30 minutes of administering intranasal desmopressin spray. Nine of 10 patients who required intramuscular diclofenac sodium achieved complete pain relief within another 30 minutes. In other words, when intranasal desmopressin spray was administered before diclofenac sodium, 94.4% of the patients achieved complete pain relief and were discharged home. The mechanism of analgesic action of desmopressin in renal colic is uncertain. At the peripheral level, desmopressin may alleviate the acute renal colic through its potent antidiuretic effect or by relaxing the renal pelvic and ureteral smooth muscles. The central analgesic effect of desmopressin by stimulating the release of the hypothalamic beta-endorphin is proposed. We conclude that intranasal desmopressin spray can be used successfully in the treatment of renal colic. It may also replace prostaglandin synthetase inhibitors in treating renal colic with the advantage of avoiding the potential side effects. Further studies are needed to investigate whether the combination of desmopressin with analgesics or spasmolytic drugs offers competitive results compared with those achieved by prostaglandin synthetase inhibitors in the treatment of renal colic.

Intramuscular Drotaverine and Diclofenac in Acute Renal Colic: A Comparative Study of Analgesic Efficacy and Safety

“…Their high-dose requirement results in significant side effect limiting their uses [8,9]. NSAIDs have been found to be effective in analgesia for renal colics but they have their possible limitations [10]. Failure to relieve pain in renal colic, defined as requirement for rescue therapy, occurs in 7% to 39% with NSAIDs [9].…”

Urological Aspects of Management

“…Ye et al [43] Nifedipine tamsulosin 3,189 96% spontaneous passage rate in tamsulosin group was significantly greater than 74% in nifedipine group Tamsulosin group also had significantly shorter stone passage interval and less ketorolac and narcotic usage Anticholinergics Erturhan et al [45] Tolterodine tamsulosin combination no-treatment 120 Spontaneous passage rate in tamsulosin group was greater at 73% compared to 70% in combination group and 47% in the tolterodine group Lv et al [46] Tolterodine no-treatment 80 Tolterodine group had better symptom scores Stone passage rates in the treatment was not different than controls Antidiuretic hormone el-Sherif et al [51] Desmopressin (non-randomized) 18 44% of patients had complete pain relief with intranasal desmopressin alone Lopes et al [52] Desmopressin ketorolac combination 61 Desmopressin and combination groups had better pain relief at 20 min compared to ketorolac alone Hazhir et al [53] Desmopressin tramadol combination 90 Desmopressin group required fewer doses of rescue medications but no difference seen in pain scores Clinic Rev Bone Miner Metab (2012) 10: 19-37 21 cascade that ultimately results in a decrease in the neuronal transmission of pain. Morphine and most other opioids activate the l receptors in the brain and spinal cord to facilitate relief of visceral and somatic pain.…”

“…Of the remaining 10 patients, 9 had complete relief with administration of ketorolac at 30 min. The authors propose a central analgesic effect to account for the rapid decrease in pain upon desmopressin administration, in addition to the drug's known antidiuretic effect [51].…”

Desmopressin as an adjuvant to opioids or NSAIDs in treatment of renal colic: a nationwide register-based study

“…However, since the 1990s, a number of reports have been published documenting an analgesic effect of desmopressin, either used alone or with a rescue dose of NSAID, in renal colic patients. 10 The mechanism of pain relief with desmopressin administration is likely because of a significant reduction in intra-ureteral mean pressure within the excretory tract with the preservation of kidney blood perfusion. In addition, desmopressin counteracts the prostaglandin-mediated down-regulation of AVP, causing an antidiuretic effect mediated by stimulation of vasopressin V2-receptors in the kidney.…”