Preassessment required based on diagnosis; see Monitor.
2 to 4 mcg daily in 2 divided doses. Adjust each dose individually for an adequate diurnal rhythm of water turnover. IV dose has 10 times the antidiuretic effect of intranasal desmopressin.
Hemophilia A and von Willebrand’s disease (Type 1):
0.3 mcg/kg of body weight. If used preoperatively, administer 30 minutes before the scheduled procedure. The necessity for repeat administration of desmopressin or the use of any blood products for hemostasis should be determined by laboratory response and the clinical condition of the patient; see Monitor.
Many specific requirements depending on diagnosis; see Limitations of Use, Precautions, and Monitor.
■ Dosing should be cautious in the elderly. Consider potential for decreased organ function and concomitant disease or drug therapy. See Elderly and Contraindications.
■ Reduce dose accordingly (to 1/10 of the intranasal dose) when transferring from intranasal to IV administration.
May be given undiluted.
Hemophilia A and von Willebrand’s disease (Type 1):
Dilute a single dose in 10 mL of NS for pediatric patients under 10 kg; 50 mL for adults and pediatric patients over 10 kg. Must be given as an infusion.
Refrigerate at 2° to 8° C (36° to 46° F). Use diluted product promptly.
A single dose by IV injection over 1 minute.
Hemophilia A and von Willebrand’s disease (Type 1):
A single dose as an infusion over 15 to 30 minutes.
A synthetic analog of the natural hormone arginine vasopressin, an antidiuretic hormone affecting renal water conservation (human antidiuretic hormone—ADH). Has been shown to be more potent than arginine vasopressin in increasing plasma levels of factor VIII activity in patients with hemophilia A and von Willebrand’s disease (Type 1). Produces dose-related increase in factor VIII levels within 30 minutes and peaks in 90 to 120 minutes. Onset of action as an antidiuretic is prompt. When administered by IV injection, desmopressin has an antidiuretic effect about 10 times that of an equivalent dose administered intranasally. Half-life is biphasic (7.8 minutes for fast phase and 75.5 minutes for slow phase). Increases water resorption in the kidney, increases urine osmolality, and decreases urine output. Increases plasma levels of von Willebrand factor, factor VIII, and t-PA, thereby contributing to a shortened activated partial thromboplastin time (aPTT) and bleeding time. Clinically effective antidiuretic doses are usually below the threshold levels for effects on vascular or visceral smooth muscle. Excreted in urine.
Antidiuretic replacement therapy in the management of central (cranial) diabetes insipidus and for the management of temporary polyuria and polydipsia following head trauma or surgery in the pituitary region.
Hemophilia A and von Willebrand’s disease (Type 1):
Indicated in patients with hemophilia A and in patients with mild to moderate classic von Willebrand’s disease (Type I) who have factor VIII coagulant activity levels greater than 5%. In both indications, desmopressin will often maintain hemostasis during surgical procedures and postoperatively when administered 30 minutes before a scheduled procedure and will also stop bleeding in episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas, or mucosal bleeding.
Ineffective for the treatment of nephrogenic diabetes insipidus.
■ Not indicated for the treatment of hemophilia A or von Willebrand’s disease (Type I) with factor VIII coagulant activity levels equal to or less than 5%; see Monitor.
■ Not indicated for the treatment of hemophilia B.
■ Not indicated in patients who have factor VIII antibodies.
■ Not indicated for the treatment of severe classic von Willebrand’s disease (Type I) and when there is evidence of an abnormal molecular form of factor VIII antigen.
Infants under 3 months of age with hemophilia A or von Willebrand’s disease, known hypersensitivity to desmopressin or any of the components of DDAVP injection, patients with moderate to severe renal impairment (CrCl less than 50 mL/min), and patients with hyponatremia or a history of hyponatremia.
A potent antidiuretic. Administration may lead to water intoxication and/or hyponatremia, which can be fatal. Fluid restriction is recommended.
■ When administered to patients who do not have a need for the antidiuretic effect, fluid intake should be adjusted downward to decrease the potential occurrence of water intoxication and hyponatremia. Pediatric and elderly patients may be at increased risk.
■ Should not be used to treat Type IIB von Willebrand’s disease; platelet aggregation may be induced.
■ Use with caution in patients with habitual or psychogenic polydipsia. May be more likely to drink excessive amounts of water, increasing their risk of hyponatremia.
■ Use caution in patients with coronary artery insufficiency or hypertensive cardiovascular disease; has infrequently produced hypertension or hypotension, with a reflex increase in heart rate.
■ Use with caution in patients predisposed to thrombus formation. There have been rare reports of thrombotic events following administration of desmopressin.
■ Patients with conditions associated with fluid and electrolyte imbalance (e.g., cystic fibrosis, CHF, renal disorders) are prone to hyponatremia; use with caution.
■ Severe hypersensitivity reactions, including anaphylaxis, have been reported.
■ See Drug Interactions.
Monitor BP and pulse during infusion.
■ Monitor fluid intake and urine volume. Monitor for S/S of hyponatremia, especially in high-risk patient populations (pediatric patients, the elderly, and patients with CHF). S/S may include headache, nausea and vomiting, decreased serum sodium, weight gain, restlessness, fatigue, lethargy, disorientation, depressed reflexes, loss of appetite, irritability, muscle weakness, muscle spasms, and abnormal mental status (e.g., confusion, decreased consciousness, hallucinations). Severe symptoms may include seizure, coma, and respiratory arrest caused by an extreme decrease in plasma osmolality.
Confirm diagnosis of diabetes insipidus with urinalysis, the water deprivation test, or the hypertonic saline infusion test.
■ Fluid restriction indicated; see Precautions.
■ Monitor continued response by measuring urine output and osmolality. Monitoring of plasma osmolality may be indicated.
■ Monitor urine specific gravity and serum electrolytes.
■ Monitor continued response by measuring urine output and osmolality.
■ Monitoring of plasma osmolality may be indicated.
■ Accuracy and effectiveness of dose measured by duration of sleep and adequate, not excessive, water turnover.
Determine factor VIII coagulant activity before administration for hemostasis.
■ Monitor factor VIII coagulant activity, factor VIII antigen, factor VIII ristocetin cofactor (von Willebrand factor), and aPTT to assess patient status during treatment.
■ Do not rely on desmopressin, but it may be considered for use in patients with factor VIII activity levels from 2% to 5% with careful monitoring. Generally used only when the factor VIII activity level is above 5%.
von Willebrand’s disease (Type 1):
Most effective when factor VIII activity level above 5%.
■ Monitor bleeding time, factor VIII coagulant activity, factor VIII ristocetin cofactor activity, and factor VIII von Willebrand factor antigen during therapy to assess patient status. Patients with severe homozygous von Willebrand’s disease with factor VIII coagulant activity and factor VIII von Willebrand factor antigen levels less than 1% are least likely to respond to treatment with desmopressin.
Hemophilia and von Willebrand’s disease:
Determine need for repeat administration of desmopressin or use of blood products by laboratory response as well as the clinical condition of the patient. Tachyphylaxis (lessening of response; i.e., a gradual diminution of the factor VIII activity increase) has been seen when given more frequently than every 48 hours.
Careful monitoring of fluid intake indicated in patients with diabetes insipidus.
■ When antidiuretic effect is not needed, caution patients (especially the young and the elderly) to limit fluid intake to satisfy thirst needs only; this decreases potential occurrence of water intoxication and hyponatremia.
Category B: use only when clearly indicated in pregnancy and breast-feeding.
■ Risk of hyponatremia and water intoxication increased in pediatric patients. Restrict fluid intake.
■ Safety for use in pediatric patients under 12 years of age with diabetes insipidus not established.
■ See Contraindications.
Risk of hyponatremia and water intoxication increased. Use caution and restrict fluid intake.
■ Response similar to that seen in younger adults. Dosing should be cautious in the elderly. Monitor renal function; see Dose Adjustments.
Has been used with aminocaproic acid without adverse effects.
■ May produce hypertension with other vasopressors (e.g., dopamine).
■ Use caution when administered concurrently with other medications that can increase the risk of water intoxication with hyponatremia (e.g., carbamazepine, chlorpromazine, lamotrigine, NSAIDs, opiate analgesics, selective serotonin reuptake inhibitors, tricyclic antidepressants).
Mild abdominal cramps, nausea, transient headache, and vulval pain are most common and may disappear with reduced doses. Facial flushing, hypertension (slight), and/or hypotension with a compensatory tachycardia have occurred. May cause burning, local erythema, and swelling at site of injection. Most serious side effects include hyponatremia with resultant sequelae (see Precautions), water intoxication, and thrombotic events (cerebrovascular thrombosis, MI). Anaphylaxis has been reported.
Confusion, continuing headache, drowsiness, problems passing urine, rapid weight gain due to fluid retention.
Hyponatremia (can be fatal), hyponatremic convulsions associated with concomitant use of oxybutynin (Ditropan) and imipramine (Tofranil-PM), thrombotic events (e.g., acute MI, acute cerebrovascular thrombosis).
Notify physician of all side effects. Most will respond to reduction of dose or rate of administration, or symptomatic treatment. May need to discontinue drug. If overdose occurs, treat by reducing dose or frequency of administration, or discontinue drug if indicated. There is no known specific antidote for desmopressin acetate. Treat hypersensitivity with oxygen, epinephrine, antihistamines (e.g., diphenhydramine), vasopressors, corticosteroids, albuterol, IV fluids, and ventilation equipment as indicated. Resuscitate as necessary.