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

DDAVP Clamp

• Eliminate unpredictable excretion of water from kidneys by stimulating V2-vasopressin receptors in the kidney, causing renal retention of water
• 2 mcg IV q8h

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

• Pregnancy Rating:Pregnancy Category B
• Lactation risk: minimally excreted in breast milk, acceptable to use

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

References

epocrates, medscape