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