No

Vasopressin Analog, Synthetic

Treatment of diabetes insipidus and controlling bleeding in mild hemophilia, von Willebrand disease, and thrombocytopenia (eg, uremia), nocturnal enuresis

B

Hypersensitivity to desmopressin or any component; avoid using in patients with type IIB or platelet-type von Willebrand disease, patients with <5% factor VIII activity level

Avoid overhydration especially when drug is used for its hemostatic effect

1% to 10%:

Cardiovascular: Facial flushing

Central nervous system: Headache, dizziness

Gastrointestinal: Nausea, abdominal cramps

Genitourinary: Vulval pain

Local: Pain at the injection site

Respiratory: Nasal congestion

<1%: Increase in blood pressure, hyponatremia, water intoxication

Symptoms of overdose include drowsiness, headache, confusion, anuria, water intoxication

Decreased effect: Demeclocycline, lithium may decrease ADH effects

Increased effect: Chlorpropamide, fludrocortisone may increase ADH response

Keep in refrigerator, avoid freezing; discard discolored solutions; nasal solution stable for 3 weeks at room temperature; injection stable for 2 weeks at room temperature

Enhances reabsorption of water in the kidneys by increasing cellular permeability of the collecting ducts; possibly causes smooth muscle constriction with resultant vasoconstriction; raises plasma levels of von Willebrand factor and factor VIII

Intranasal administration:

Onset of ADH effects: Within 1 hour

Peak effect: Within 1-5 hours

Duration: 5-21 hours

I.V. infusion:

Onset of increased factor VIII activity: Within 15-30 minutes

Peak effect: 90 minutes to 3 hours

Absorption: Nasal: Slow; 10% to 20%

Metabolism: Unknown

Half-life: Elimination (terminal): 75 minutes

Children:

Diabetes insipidus: 3 months to 12 years: Intranasal (using 100 mcg/mL nasal solution): Initial: 5 mcg/day (0.05 mL/day) divided 1-2 times/day; range: 5-30 mcg/day (0.05-0.3 mL/day) divided 1-2 times/day; adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover

Hemophilia: >3 months: I.V. 0.3 mcg/kg; may repeat dose if needed; begin 30 minutes before procedure; dilute I.V. dose in 50 mL 0.9% sodium chloride and infuse over 15-30 minutes

Nocturnal enuresis: greater than or equal to 6 years: Intranasal (using 100 mcg/mL nasal solution): Initial: 20 mcg (0.2 mL) at bedtime; range: 10-40 mcg; it is recommended that 1/2 of the dose be given in each nostril

Children 12 years and Adults:

Diabetes insipidus:

I.V., S.C.: 2-4 mcg/day in 2 divided doses or 1/10 of the maintenance intranasal dose; dilute I.V. dose in 50 mL 0.9% sodium chloride and infuse over 15-30 minutes

Intranasal (using 100 mcg/mL nasal solution): 5-40 mcg/day (0.05-0.4 mL) divided 1-3 times/day; adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. Note: The nasal spray pump can only deliver doses of 10 mcg (0.1 mL) or multiples of 10 mcg (0.1 mL), if doses other than this are needed, the rhinal tube delivery system is preferred.

Hemophilia/uremic bleeding:

I.V.: 0.3 mcg/kg by slow infusion, begin 30 minutes before procedure; dilute I.V. dose in 50 mL 0.9% sodium chloride and infuse over 15-30 minutes

Nasal spray: Using high concentration spray: <50 kg: 150 mcg (1 spray); >50 kg: 300 mcg (1 spray each nostril); repeat use is determined by the patient's clinical condition and laboratory work; if using preoperatively, administer 2 hours before surgery

Oral: Begin therapy 12 hours after the last intranasal dose for patients previously on intranasal therapy

Children: Initial: 0.05 mg; fluid restrictions are required in children to prevent hyponatremia and water intoxication

Adults: 0.05 mg twice daily; adjust individually to optimal therapeutic dose. Total daily dose should be increased or decreased (range: 0.1-1.2 mg divided 2-3 times/day) as needed to obtain adequate antidiuresis.

Blood pressure and pulse should be monitored during I.V. infusion

Hemophilia: Factor VIII antigen levels, APTT, bleeding time (for von Willebrand disease and thrombocytopathies)

May cause dizziness

May decrease lithium's effect on ADH, however, hydrochlorothiazide or amiloride are better choices

No information available to require special precautions

No effects or complications reported

Use specific product as directed. Diabetes insipidus: Avoid overhydration. Weigh yourself daily at the same time in the same clothes. Report increased weight or swelling of extremities. If using intranasal product, inspect nasal membranes regularly. Report swelling or increased nasal congestion. All uses: Report unresolved headache, difficulty breathing, acute heartburn or nausea, abdominal cramping, or vulval pain. Breast-feeding precautions: Consult prescriber if breast-feeding.

Parenteral: Dilute to a maximum concentration of 0.5 mcg/mL in normal saline and infuse over 15-30 minutes

Injection (DDAVP®): 4 mcg/mL (1 mL)

Solution, nasal:

DDAVP®: 100 mcg/mL (2.5 mL, 5 mL)

Stimate™: 1.5 mg/mL (2.5 mL)

Tablet (DDAVP®): 0.1 mg, 0.2 mg

Asplund R and Aberg H, "Desmopressin in Elderly Subjects With Increased Nocturnal Diuresis: A Two-Month Treatment Study," Scand J Urol Nephrol, 1993, 27(1):77-82.

Cattaneo M, "Review of Clinical Experience of Desmopressin in Patients With Congenital and Acquire Bleeding Disorder," Eur J Anesthesiol Suppl, 1997, 14:10-4.

Chistolini A, Dragoni F, Ferrari A, et al, "Intranasal DDAVP®: Biological and Clinical Evaluation in Mild Factor VIII Deficiency," Haemostasis, 1991, 21(5):273-7.

Lindeman RD, Lee TD Jr, Yiengst MJ, et al, "Influence of Age, Renal Disease, Hypertension, Diuretics, and Calcium on the Antidiuretic Responses to Suboptimal Infusions of Vasopressin," J Lab Clin Med, 1966, 68(2):206-23.

Lusher JM, "Response to 1-Deamino-8-D-Arginine Vasopressin in von Willebrand Disease," Haemostasis, 1994, 24(5):276-84.

Mannucci PM and Cattaneo M, "Desmopressin: A Nontransfusional Treatment of Hemophilia and von Willebrand Disease," Haemostasis, 1992, 22(5)276-80.

Richardson DW and Robinson AG, "Desmopressin," Ann Intern Med, 1985, 103(2):228-39.

Stenberg A and Läckgren G, "Desmopressin Tablets in the Treatment of Severe Nocturnal Enuresis in Adolescents," Pediatrics, 1994, 94(6 Pt 1):841-46.