Trade Names:DDAVP- Tablets 0.1 mg- Tablets 0.2 mg- Injection 4 mcg/mL
Trade Names:DDAVP Rhinal Tube- Nasal solution 0.1 mg (0.1 mg/mL equals arginine vasopressin 400 units)
Trade Names:Stimate- Nasal spray 1.5 mg/mLApo-Desmopressin (Canada)DDAVP Rhinyle Nasal Solution (Canada)Minirin (Canada)Novo-Desmopressin (Canada)Octostim (Canada)
Has antidiuretic effect that decreases urinary volume and increases urine osmolality.
T max is 0.9 h.Stimate nasal spray
T max is 1.5 h.
Half-life is 1.5 to 2.5 h.IV and DDAVP nasal solution
Half-life is 7.8 and 75.5 min for the fast and slow phases, respectively.Stimate nasal spray
Half-life is 3.3 to 3.5 h.
Approximately 1 h (oral), within 30 min to increase factor VIII (IV and intranasal).
4 to 7 h (oral), 1.5 to 2 h to increase factor VIII (IV and intranasal).
8 to 12 h (oral).
Antidiuretic replacement therapy in the management of central diabetes insipidus; management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region.Injection, Stimate nasal spray
Maintenance of hemostasis in patients with hemophilia A or mild to moderate von Willebrand disease (type I) with factor VIII coagulant activity more than 5%.Tablets
Control of primary nocturnal enuresis.
Treatment of chronic autonomic failure.
Moderate to severe renal function impairment (CrCl below 50 mL/min); hyponatremia or a history of hyponatremia; hypersensitivity to any component of the product.
PO Start with 0.05 mg 2 times daily and adjust for an adequate diurnal rhythm of water turnover. Increase or decrease the dose in the range of 0.1 to 1.2 mg divided into 2 or 3 daily doses as needed to obtain adequate antidiuresis.Adults and Children 12 yr of age and older
IV / Subcutaneous Adult range is 2 mcg (0.5 mL) to 4 mcg (1 mL) daily, usually in 2 divided doses.Adults and Children 12 yr of age and older
DDAVP nasal solution 0.1 to 0.4 mL daily, either as a single dose or divided into 2 or 3 doses.Children 3 months to 12 yr of age
DDAVP nasal solution 0.05 to 0.3 mL daily, either as a single dose or divided into 2 doses.Hemophilia A, Type I von Willebrand DiseaseAdults and Children 3 mo of age and older
IV Administer 0.3 mcg/kg diluted in sterile physiologic saline infused slowly over 15 to 30 min. In patients weighing more than 10 kg, use 50 mL diluent; in children weighing up to 10 kg, use 10 mL.Adults and Children 11 mo of age and older
Stimate nasal spray Administer by nasal insufflation, 1 spray per nostril, to provide a total dose of 300 mcg. In patients weighing less than 50 kg, 150 mcg administered as a single spray provided the expected effect on factor VIII coagulant activity, factor VIII ristocetin cofactor activity, and skin bleeding time.Primary Nocturnal DiuresisAdults and Children 6 yr of age and older
PO Start with 0.2 mg at bedtime. The dose may be titrated up to 0.6 mg to achieve the desired response. Fluid restriction should be observed and fluid intake should be limited to a minimum from 1 h before desmopressin administration until the next morning or at least 8 h after administration.
Refrigerate nasal solution (36° to 46°F). Nasal solution will maintain stability for up to 3 wk when stored at room temperature. Store Stimate nasal spray at room temperature, below 77°F. Refrigerate injectable solution (36° to 46°F). Store oral tablets at 68° to 77°F. Avoid exposure to excessive heat or light.
Use with caution because of increased risk of water intoxication with hyponatremia.
None well documented.
Blood pressure changes causing slight elevation or transient falls and a compensatory increase in heart rate (injection); facial flushing (injection, intranasal); palpitations, tachycardia ( Stimate ); thrombotic events including acute cerebrovascular thrombosis and acute MI (injection) (postmarketing).
Headache (5%); dizziness (3%); asthenia (2%); abnormal thinking (injection, intranasal, oral); agitation, insomnia, somnolence ( Stimate ).
Rhinitis (8%); epistaxis (3%); conjunctivitis, eye edema, lacrimation disorder, nostril pain (2%); nasal congestion, nosebleed, rhinitis, sore throat (intranasal); itchy or light-sensitive eyes ( Stimate ).
Abdominal pain, GI disorder, nausea (2%); diarrhea; mild abdominal cramps (injection, intranasal); dyspepsia, vomiting ( Stimate ).
Vulval pain (injection); balanitis ( Stimate ).
Severe allergic reactions including anaphylaxis (injection).
Transient increases in AST (oral).
Burning pain, local erythema, swelling (injection).
Hyponatremia, water intoxication, weight gain due to edema.
Cough, upper respiratory tract infections (intranasal).
Chills (2%); chest pain, edema, pain, warm feeling ( Stimate ).
Monitor BP and pulse during infusion. Monitor I&O closely and accurately when drug is administered to very young and elderly patients. Monitor patient at regular intervals during the course of tablet therapy to ensure adequate antidiuretic response. Laboratory tests for monitoring patients with central diabetes insipidus or postsurgical or head trauma-related polyuria and polydipsia include urine volume and osmolarity. Perform laboratory tests assessing factor VIII coagulant activity before giving desmopressin for hemostasis. If factor VIII coagulant activity is less than 5% of normal, do not rely on desmopressin.
Category B .
Use in infants and children requires careful fluid intake restriction to prevent possible hyponatremia and water intoxication.Central diabetes insipidus
The desmopressin tablets have been used safely in children 4 yr of age and older. In younger children, the dose must be individually adjusted in order to prevent an excessive decrease in plasma osmolality, leading to hyponatremia and possible convulsions. Safety and efficacy not established for desmopressin injection in patients younger than 12 yr of age.DDAVP nasal solution
Dosing recommendations are available for children 3 mo of age and older.Primary nocturnal enuresis
The tablets have been used safely in children 6 yr of age and older.Hemophilia A or von Willebrand disease
Desmopressin 4 mcg/mL injection should not be used in infants younger than 3 mo of age. Safety and efficacy not established for use of Stimate nasal spray in children younger than 11 mo of age.
Use with caution, usually starting at the low end of the dosage range, because of the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant diseases or other drug therapy.
Rare, severe allergic reactions have been reported; anaphylaxis has been reported with IV and intranasal, but not oral, administration.
Use with caution in patients with habitual or psychogenic polydipsia who may be more likely to drink excessive amounts of water; use with caution in patients with conditions associated with fluid and electrolyte imbalance (eg, cystic fibrosis, heart failure, renal disorder) because these patients are prone to hyponatremia. Because rare thrombotic events have been reported, use with caution in patients predisposed to thrombus formation. Use with caution in patients with coronary artery insufficiency and/or hypertensive CV disease.
Check coagulation status prior to treating patients with hemophilia A and type I von Willebrand disease. Coagulation testing may include factor VIII coagulant activity, factor VIII antigen, ristocetin cofactor, activated PTT, and skin bleeding time.
An extreme decrease in plasma osmolality occurs rarely and may result in seizures and coma.
Parenteral and high-dose intranasal administration may cause slight elevation of BP, which reverses with dose reduction
Since water intoxication and/or hyponatremia may occur, fluid restriction is recommended. In children and elderly patients, in particular, adjust fluid intake downward to decrease the potential for water intoxication and hyponatremia.
Changes in the nasal mucosa such as scarring, edema, or other disease may cause erratic, unreliable absorption; in which case, discontinue the intranasal route until the problem resolves and consider the injection.
Confusion, drowsiness, headache, problems with passing urine, rapid weight gain due to fluid retention.
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