desflurane, isoflurane, and sevoflurane anaesthesia. Can J
tolerated in seasonal allergic rhinitis, including relief
ofnasal congestion (24).
atadine in 346 patients with seasonal allergic rhinitis,
thesymptoms improved significantly and therewasno significant
urticaria, with no adverse electrocardiographic effects
(8).References
1. Westrin P. Intravenous and inhalational anaesthetic
agents.
Baillie`res Clin Anaesthesiol 1996;10:687715.
2. Anonymous. Sevoflurane and desflurane: comparison with
older inhalational anaesthetics. Drugs Ther Perspect
1996;7:15.
3. Eger EI 2nd. Desflurane animal and human pharmacology:
aspects of kinetics, safety, and MAC. Anesth Analg
1992;75(Suppl 4):S39.
4. Song D, Joshi GP, White PF. Fast-track eligibility after
ambulatory anesthesia: a comparison of desflurane,
sevoflurane, and propofol. Anesth Analg 1998;86(2):26773.
5. Rodig G, Wild K, Behr R, Hobbhahn J. Effects of desflur-
ane and isoflurane on systemic vascular resistance during
hypothermic cardiopulmonary bypass. J Cardiothorac Vasc
Anesth 1997;11(1):547.
6. Warltier DC, Pagel PS. Cardiovascular and respiratory
actions of desflurane: is desflurane different from isoflur-
ane? Anesth Analg 1992;75(Suppl 4):S1731.
7. Bunting HE, Kelly MC, Milligan KR. Effect of nebulized
lignocaine on airway irritation and haemodynamic changes
during induction of anaesthesia with desflurane. Br J
Anaesth 1995;75(5):6313.
8. Bennett JA, Lingaraju N, Horrow JC, McElrath T,
Keykhah MM. Elderly patients recover more rapidly from
desflurane than from isoflurane anesthesia. J Clin Anesth
1992;4(5):37881.
9. Zwass MS, Fisher DM, Welborn LG, Cote CJ, Davis PJ,
Dinner M, Hannallah RS, Liu LM, Sarner J, McGill WA,
et al Induction and maintenance characteristics of
anesthesia with desflurane and nitrous oxide in infants
and children. Anesthesiology 1992;76(3):3738.
10. Ornstein E, Young WL, Fleischer LH, Ostapkovich N.
Desflurane and isoflurane have similar effects on cerebral
blood flow in patients with intracranial mass lesions.
Anesthesiology 1993;79(3):498502.
11. Kelly RE, Lien CA, Savarese JJ, Belmont MR,
Hartman GS, Russo JR, Hollmann C. Depression of neuro-
muscular function in a patient during desflurane anesthesia.
Anesth Analg 1993;76(4):86871.
12. Weiskopf RB, Eger EI 2nd, Ionescu P, Yasuda N,
Cahalan MK, Freire B, Peterson N, Lockhart SH,
Rampil IJ, Laster M. Desflurane does not produce hepatic
or renal injury in human volunteers. Anesth Analg
1992;74(4):5704.
13. Berghaus TM, Baron A, Geier A, Lamerz R,
Paumgartner G, Conzen P. Hepatotoxicity following des-
flurane anesthesia. Hepatology 1999;29(2):61314.
14. Annila P, Rorarius M, Reinikainen P, OikkonenM, Baer G.
Effect of pre-treatment with intravenous atropine or
glycopyrrolate on cardiac arrhythmias during halothane
anaesthesia for adenoidectomy in children. Br J Anaesth
1998;80(6):75660.
15. Fu ES, Scharf JE, Mangar D, Miller WD. Malignant
hyperthermia involving the administration of desflurane.
Can J Anaesth 1996;43(7):68790.
16. Gold MI, Abello D, Herrington C. Minimum alveolar
concentration of desflurane in patients older than 65 yr.
Anesthesiology 1993;79(4):71014.
17. Moore MA, Weiskopf RB, Eger EI 2nd, Wilson C, Lu G.
Arrhythmogenic doses of epinephrine are similar during
desflurane or isoflurane nesthesia in humans.
Anesthesiology 1993;79(5):9437.
18. Sebel PS, Glass PS, Fletcher JE, Murphy MR, Gallagher C,
Quill T. Reduction of the MAC of desflurane with fentanyl.
Anesthesiology 1992;76(1):529.
1074 Desloratadine19. Eriksson H, Korttila K. Recovery profile
after desflurane
with or without ondansetron compared with propofol in
2006 Elsevier B.V. All rights reserved.In healthy volunteers, 12
men and 12 women, there wasno prolongation of the QTc interval
after co-administrationof desloratadine with erythromycin (9).
Nervous system
Desloratadine appears to be minimally sedative, giventhat
several studies, published in abstract, have shownno impairment in
terms of wakefulness or psychomotorperformance (1012). Moreover, in
a study in whicheffect on the QTc interval (7).In a multicenter,
randomized, double-blind, placebo-
controlled study in 190 patients, desloratadine was effectivein
the treatment of moderate to severe chronic idiopathicIn a
randomized, open, four-way, crossover study in 20healthy men
desloratadine was given as single doses (5,7.5, 10, and 20mg) in
four different treatment periodswith 14 days between each dose. The
Cmax for all dosesoccurred at 4 hours after administration, with a
half-life of2124 hours. There were no dose-related differences
indrug absorption rate, and even the 20mg dose was welltolerated
(5). The systemic availability of desloratadinewas unaffected by
food in healthy adult volunteers (6).
Organs and Systems
Cardiovascular
In a large, multicenter, double-blind,
placebo-controlled,parallel-group study of the efficacy and
tolerability of deslor-Anaesth 1998;45(6):52632.
Desloratadine
See also Antihistamines
General Information
Desloratadine is the primary metabolite of loratadine,with
superior H1 receptor binding, potent antihistaminicactivity
compared with the parent compound, and provenefficacy in allergic
disease (1). It is effective and wellpatients undergoing outpatient
gynecological laparoscopy.
Anesth Analg 1996;82(3):5338.
20. Lowry DW, Mirakhur RK, Carrol MT. Time course of
action of rocuronium during sevoflurane, isoflurane or i.v.
anaesthesia. Br J Anaesth 1998;80:544.
21. Wulf H, Ledowski T, Linstedt U, Proppe D, Sitzlack D.
Neuromuscular blocking effects of rocuronium duringdesloratadine
was effective and well tolerated in patientswith seasonal allergic
rhinitis there were no clinicallysignificant sedative effects
(7).
hydramine and desloratadine on vigilance and cognitive
function during treatment of ragweed-induced allergic rhi-
Desloratadine shows no effect on performance during 6 hat 8,000
ft simulated cabin altitude. Aviat Space Environ
Med 2004;75(5):4338.
16. Affrime M, Banfield C, Gupta S, Cohen A, Boutros T,
Thonoor M, Cayen M. Effect of race and sex on single and
multiple dose pharmacokinetics of desloratadine. Clin
Pharmacokinet 2002;41(Suppl 1):218.
17. Affrime M, Gupta S, Banfield C, Cohen A. A pharmaco-
kinetic profile of desloratadine in healthy adults,
including
elderly. Clin Pharmacokinet 2002;41(Suppl 1):1319.
18. Gupta S, Banfield C, Kantesaria B, Marino M, Clement R,
Affrime M, Batra V. Pharmacokinetic and safety profile of
desloratadine and fexofenadine when coadministered with
azithromycin: a randomized, placebo-controlled, parallel-
group study. Clin Ther 2001;23(3):45166.
19. Gupta S, Banfield C, Kantesaria B, Flannery B, Herron J.
Pharmacokinetics/pharmacodynamics of desloratadine and
fluoxetine in healthy volunteers. J Clin Pharmacol
2004;44(11):12529.
20. Banfield C, Gupta S, Marino M, Lim J, Affrime M.
Grapefruit juice reduces the oral bioavailability of fexo-
fenadine but not desloratadine. Clin Pharmacokinet
2002;41(4):31118.
21. Banfield C, Herron J, Keung A, Padhi D, Affrime M.
Desloratadine has no clinically relevant electrocardio-
graphic or pharmacodynamic interactions with ketocona-
zole. Clin Pharmacokinet 2002;41(Suppl 1):3744.
Desmopressin
See also Vasopressin and analogues
General Information
Desmopressin (N-deamino-8-D-arginine vasopressin,dDAVP) is a
longer acting analogue of vasopressin. It hasvery little vasoactive
effect but is antidiuretic by anaction on vasopressin V2 receptors
in the renal tubuleand is used to treat central diabetes insipidus
and noc-turnal enuresis.At higher doses desmopressin also has
significant
hematological effects and can significantly boost concen-nitis.
Ann Allergy Asthma Immunol 2003;91(4):37585.
14. Nicholson AN, Handford AD, Turner C, Stone BM. Studies
on performance and sleepiness with the H1-antihistamine,
desloratadine. Aviat Space Environ Med 2003;74(8):80915.
15. Valk PJ, Van Roon DB, Simons RM, Rikken G.11. Vuurman E,
Ramaekers JG, Rikken G, De Halleux F.
Desloratadine does not impair actual driving performance:
a three way crossover comparison with diphenhydramine
and placebo. Allergy 2000;55(Suppl 63):Abstract 263.
12. Valk PJL, Van Roon DB, Simons M, Rikken G, Lether IC,
Staudinger H. No impairment of flying ability with deslor-
atadine use in healthy volunteers under conditions of simu-
lated cabin pressure. Allergy 2001;56(Suppl 68):Abstract
229.
13. Wilken JA, Kane RL, Ellis AK, Rafeiro E, Briscoe MP,
Sullivan CL, Day JH. A comparison of the effect of diphen-
1076 Desmopressintrations of factor VIII and von Willebrand
factor (VWF)in the blood. Desmopressin is therefore a valuable
agentfor the treatment of mild and moderate hemophilia
2006 Elsevier B.V. All rights reserved.A (congenital or
acquired) and type 1 von Willebranddisease, in which the VWF
protein structure is normalbut the plasma concentration is reduced
(1). By contrastwith conventional coagulation factor concentrates,
des-mopressin is cheap and is free from the risk of transmis-sion
of viral infections, which have proved such a problemin the past.
It is also very useful in the treatment ofcarriers of hemophilia A,
many of whom have significantreductions in the baseline
concentration of factor VIII. Bycontrast, desmopressin has no
effect on the concentrationof factor IX, and is thus of no value in
hemophilia B(Christmas disease). It is also of little value in type
2(abnormal VWF structure) von Willebrands disease,which accounts
for about 1520% of all cases. The admin-istration of desmopressin
to patients with type 2B vonWillebrands disease can be hazardous,
as it is likely tocause thrombocytopenia (2). The use of
desmopressin inbleeding disorders has been reviewed (3).
Tachyphylaxisdevelops if desmopressin is used for prolonged periods
tocontrol bleeding disorders, because desmopressin causesrelease of
stored factor VIII and von Willebrand factor,after which it takes
time for them to accumulate again.Intravenous injection is the most
common route
although subcutaneous injection may also be used. Aconcentrated
nasal spray formulation has been proved tobe efficient for home
treatment of patients with bleedingepisodes or even minor surgical
procedures and has alsobeen used prophylacticly (4). The nasal
spray used totreat diabetes insipidus (Desmospray) is too dilute
foruse in disorders of hemostasis. Similarly, desmopressinin tablet
form (Desmotabs) is intended for treatment ofnocturnal enuresis in
children and is of no use in thetreatment of hemostatic
disorders.Desmopressin also shortens the prolonged skin bleed-
ing time in patients with renal insufficiency (5,6),
hepaticcirrhosis (7,8), and congenital or acquired defects
ofplatelet function (911), including aspirin-induced plate-let
dysfunction (12).Desmopressin reduces blood loss in patients
without
bleeding disorders during surgical procedures, includingcardiac
surgery (13,14). However, similar benefits havealso been observed
with other agents, including aprotinin,tranexamic acid, and
aminocaproic acid. Meta-analyseshave confirmed the efficacy of
these agents and haveshown that aprotinin is the most effective of
these agentsin reducing blood loss, while desmopressin was the
leasteffective (15,16).Children with nocturnal enuresis treated
with desmo-
pressin have fewer wet nights per week, but this effectdoes not
persist after therapy is stopped. A meta-analysisshowed an overall
rate of 7.1 adverse events per 100children (17). These were almost
all local nasal reactions,including nasal irritation and
epistaxis.In an open trial of high-dose desmopressin 1.5mg
intra-
nasally to control bleeding in 278 patients with
congenitalbleeding disorders, headache occurred in 3.6% and
flush-ing in 3.2% of patients (18). Dizziness and nausea
werereported in 11.5% and edema in 0.3% of patients.
General adverse effectsThe adverse effects of desmopressin
include headache,tachycardia, facial flushing, abdominal pain,
tremor, and
DesloratadineSee alsoGeneral InformationOrgans and
SystemsCardiovascularNervous systemPsychological, psychiatric
Susceptibility FactorsGenetic factorsAgeSex
Drug-Drug
InteractionsAzithromycinErythromycinFluoxetineGrapefruit
juiceKetoconazole
References
