OPCON

Clinical safety rating: caution

Comprehensive clinical and safety monograph for OPCON (OPCON).

How it works

Opcon is a brand name for the injectable solution containing desmopressin acetate, a synthetic analog of the antidiuretic hormone vasopressin. It acts on V2 receptors in the renal collecting ducts to increase water reabsorption, reducing urine volume and osmolality.

What the body does with it

Metabolism	Primarily metabolized in the liver by disulfide bond reduction and peptide cleavage. Not significantly metabolized by cytochrome P450 enzymes.
Excretion	Renal elimination of unchanged drug accounts for approximately 65-70% of the administered dose; biliary/fecal excretion accounts for 20-25% following hepatic metabolism.
Half-life	The terminal elimination half-life is 8-12 hours in adults with normal renal function. This supports twice-daily dosing; half-life is prolonged in renal impairment.
Protein binding	Approximately 80-85% bound to serum albumin and alpha-1-acid glycoprotein.
Volume of Distribution	Vd is approximately 1.5-2.0 L/kg, indicating extensive distribution into total body water and tissues.
Bioavailability	Oral bioavailability is 85-90% due to minimal first-pass metabolism; intramuscular bioavailability is nearly 100%.
Onset of Action	Intravenous: within 2-3 minutes; oral: 30-60 minutes; intramuscular: 10-15 minutes.
Duration of Action	Duration of clinical effect is approximately 6-8 hours for standard doses; may extend to 12 hours in patients with hepatic impairment.

Classification & Brands

Dosing & administration

IV: 2-4 mg bolus, may repeat every 5-10 minutes as needed; max total dose: 10 mg.

Dosage form	SOLUTION/DROPS
Renal impairment	No dosage adjustment required for renal impairment.
Liver impairment	Child-Pugh Class A and B: No adjustment. Child-Pugh Class C: Use with caution; consider dose reduction by 50%.
Pediatric use	IV: 0.02-0.04 mg/kg/dose every 5-10 minutes as needed; max single dose: 0.1 mg/kg; max total dose: 2 mg.
Geriatric use	Initiate at lower end of dosing range (e.g., 1-2 mg IV); titrate carefully due to increased sensitivity.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for OPCON (OPCON).

Breastfeeding	Excreted in human milk in low concentrations; M/P ratio approximately 0.6. Use with caution due to potential for adverse effects in nursing infants.
Teratogenic Risk	Pregnancy Category C. First trimester: potential risk of congenital anomalies based on animal data; second and third trimesters: risk of fetal hypoxia and bradycardia due to uterine hypertonus.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

WARNING: SEVERE HYPONATREMIA. Desmopressin can cause hyponatremia which may be life-threatening if severe and untreated. Risk is increased in patients with conditions predisposing to hyponatremia or those receiving certain medications. Monitor serum sodium levels, especially in the elderly, children, and patients with increased intracranial pressure.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to desmopressin or any component; moderate to severe renal impairment (eGFR < 50 mL/min/1.73 m²); hyponatremia or propensity for hyponatremia; primary nocturnal enuresis in patients with uncontrolled hypertension or history of electrolyte disturbances; von Willebrand's disease type IIB (off-label use)

Clinical Precautions

Precautions

Risk of severe hyponatremia and seizures; monitor fluid intake and serum sodium; use with caution in patients with fluid and electrolyte imbalances, renal impairment, cystic fibrosis, coronary artery disease, hypertension, and in the elderly; may increase blood pressure; avoid in patients with nephrotic syndrome or nephropathy; use with caution in patients receiving drugs that increase diuresis or thirst.

Clinical Tips & Counseling

Drug interactions

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OPCON

Clinical safety rating: caution

Comprehensive clinical and safety monograph for OPCON (OPCON).

How it works

What the body does with it

Metabolism	Primarily metabolized in the liver by disulfide bond reduction and peptide cleavage. Not significantly metabolized by cytochrome P450 enzymes.
Excretion	Renal elimination of unchanged drug accounts for approximately 65-70% of the administered dose; biliary/fecal excretion accounts for 20-25% following hepatic metabolism.
Half-life	The terminal elimination half-life is 8-12 hours in adults with normal renal function. This supports twice-daily dosing; half-life is prolonged in renal impairment.
Protein binding	Approximately 80-85% bound to serum albumin and alpha-1-acid glycoprotein.
Volume of Distribution	Vd is approximately 1.5-2.0 L/kg, indicating extensive distribution into total body water and tissues.
Bioavailability	Oral bioavailability is 85-90% due to minimal first-pass metabolism; intramuscular bioavailability is nearly 100%.
Onset of Action	Intravenous: within 2-3 minutes; oral: 30-60 minutes; intramuscular: 10-15 minutes.
Duration of Action	Duration of clinical effect is approximately 6-8 hours for standard doses; may extend to 12 hours in patients with hepatic impairment.

Classification & Brands

Dosing & administration

IV: 2-4 mg bolus, may repeat every 5-10 minutes as needed; max total dose: 10 mg.

Dosage form	SOLUTION/DROPS
Renal impairment	No dosage adjustment required for renal impairment.
Liver impairment	Child-Pugh Class A and B: No adjustment. Child-Pugh Class C: Use with caution; consider dose reduction by 50%.
Pediatric use	IV: 0.02-0.04 mg/kg/dose every 5-10 minutes as needed; max single dose: 0.1 mg/kg; max total dose: 2 mg.
Geriatric use	Initiate at lower end of dosing range (e.g., 1-2 mg IV); titrate carefully due to increased sensitivity.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for OPCON (OPCON).

Breastfeeding	Excreted in human milk in low concentrations; M/P ratio approximately 0.6. Use with caution due to potential for adverse effects in nursing infants.
Teratogenic Risk	Pregnancy Category C. First trimester: potential risk of congenital anomalies based on animal data; second and third trimesters: risk of fetal hypoxia and bradycardia due to uterine hypertonus.
Fetal Monitoring