Desmopressin

Administration
  • Type: synthetic replacement for vasopressin
  • Dosage Forms:
    • injectable solution: 4 mcg/mL
    • tablet: 0.1mg, 0.2mg
    • nasal spray: 0.1mg/ mL (5mL); Delivers 10 mcg/spray, 1.5mg/mL (2.5mL); Delivers 150 mcg/spray
  • Routes of Administration: IV, IM, SC, intranasal, oral
  • Common Trade Names: DDAVP, Stimate

Adult Dosing

Diabetes Insipidus
  • Intranasal: 10-40 mcg/day qday or divided q8-12 hr
  • PO:
    • Initial: 0.05mg q 12 hr
    • Effective range: 0.1-1.2mg divided q 8-12 hr
  • IV/SC: 2-4 mcg/day divided q12 hr or 1/10th the maintenance of intranasal dose

Hemophilia A & Von Willebrand Disease
  • IV: 0.3 mcg/kg IV over 15-30 minutes IV (for pre-op 30 min before procedure)
  • intranasal:
    • <50 kg: 150 mcg; for pre-op, give 2 hr before procedure
    • >50 kg: 300 mcg; for pre-op, give 2 hr before procedure

Nocturnal Enuresis
  • 0.2mgPO qHS (up to 0.6mg/day)

Uremic Bleeding in Acute or Chronic Renal Failure
  • 0.4 mcg/kg IV over 10 minutes

Pediatric Dosing

Diabetes Insipidus

3 months to 12 years (intranasal)
  • 5-30 mcg/day qday or divided q12 hr (using 100 mcg/mL solution)

>12 years (intranasal)
  • 10-40mcg/day qday or divided q12 hr (using 100 mcg/mL solution)

3 months to 12 years (oral)
  • Initial: 0.05mg q 12 hr
  • Effective range: 0.1-1.2mg

>12 years (oral)
  • Initial 0.05mg PO q 12 hr
  • Effective range: 0.1-1.2mg divided q8-12 hr

3 months to 12 years (IV/SC)
  • 0.1-1 mcg qday or divded q12 hr

>12 years (IV/SC)
  • 2-4 mcg/day divided q 12 hr or one tenth the maintenance of intranasal dose

Nocturnal Enuresis
  • >6 years: 0.2mg PO qHS; up to 0.6mg/day

Hemophilia A & Von Willebrand Disease
  • 0.3 mcg/kg IV over 15-30 minutes; for pre-op, give 30 minutes before procedure
  • 1 spray (150 mcg) per nostril (300 mcg total dose) if >12 years of age or >50 kg body weight
  • administer single spray (150 mcg) if patient >12 years of age but <50 kg body weight
  • (Fluid intake should be limited 1 hr prior to dose until the next morning or at least 8 hr after administration)

Special Populations

Renal Dosing
  • CrCl <50 mL/min: Contraindicated; has been used unlabeled in acute and chronic renal failure patients experiencing uremic bleeding or prevention of surgical bleeding, limit to 1 dose
  • CrCl ≥50 mL/min: No adjustments necessary

Hepatic Dosing
  • not defined

Contraindications
  • Allergy to class/drug
  • patients <3 months (hemophilia A or von Willebrand disease patients)
  • CrCl <50
  • von Willebrand disease, type IIB
  • hyponatremia

Caution to use
  • renal impairment
  • fluid and electrolyte imbalance
  • polydipsia
  • elderly patients
  • young children
  • cystic fibrosis
  • coronary artery disease
  • hypertension
  • Congestive Heart Failure
  • thrombosis risk

Adverse Reactions

Serious
  • anaphylaxis
  • respiratory arrest
  • hyponatremia
  • water intoxication
  • seizures
  • thrombosis

Common
  • flushing
  • headache
  • rhinitis
  • nausea
  • abdominal pain
  • dizziness
  • cough
  • epistaxis
  • rigors
  • conjunctivitis
  • hypertension
  • hypotension

Pharmacology
  • Half-life: 1.5 -2.5 hr (oral); 3 hr (IV)
  • Metabolism: kidney; CYP 450
  • Excretion: urine primarily

Mechanism of Action
  • synthetic arginine vasopressin (antidiuretic hormone) analogue; exerts antidiuretic effects and increases plasma factor VIII and von Willebrand factor levels

Comments

See Also

References

    epocrates, medscape

    This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.