View source for 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<ref>Sood L et al. Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia. Am J Kidney Dis
. 2013 Apr;61(4):571-8. doi: 10.1053/j.ajkd.2012.11.032. Epub 2012 Dec 23.</ref>

==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==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:Pregnancy Category B
*[[Lactation risk categories|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

==Comments==

==See Also==

==References==
<references/>
[[Category:Pharmacology]]
epocrates, medscape