Desmopressin acetate
Desmopressin acetate (DDAVP, Stimate)
Desmopressin acetate
(des-moh- PRESS-in)
Pregnancy Category: B DDAVP DDAVP Nasal Solution Octostim Rhinyle Nasal Solution Stimate (Rx)

Classification: Antidiuretic hormone, synthetic

Action/Kinetics: A synthetic analog of arginine vasopressin which possesses antidiuretic activity but is devoid of vasopressor and oxytocic effects. Acts to increase absorption of water in the kidney by increasing permeability of cells in the collecting ducts. Onset: 1 hr. Peak, intranasal: 1-5 hr.; peak, PO: 4-7 hr. Duration: 8-20 hr. t 1/2: initial, 8 min; final: 75 min. Effect ceases abruptly. It also increases factor VIII levels ( onset: 30 min; peak: 1.5-2 hr) and von Willebrand's factor activity. Time to reach maximum plasma levels, after PO or intranasal: 0.9-1.5 hr.

Uses: DDAVP: Primary noctural enuresis (intranasal, tablet), central cranial DI (intranasal, oral, parenteral), hemophilia A with factor VIII levels greater than 5% (intranasal, parenteral), von Willebrand's disease (type I) with factor VIII levels greater than 5% (intranasal, parenteral). Stimate: Hemophilia A with factor VIII levels greater than 5%, von Willebrand's disease with factor VIII levels greater than 5%.
Investigational: Chronic autonomic failure (nocturnal polyuria, overnight weight loss, morning postural hypotension).

Contraindications: Hypersensitivity to drug. Use for treatment of hemophilia A with factor VIII levels less than or equal to 5%, treatment of hemophilia B or in clients who have factor VIII antibodies. Treatment of severe classic von Willebrand's disease (type I) and when an abnormal molecular form of factor VIII antigen is present. Use for type IIB von Willebrand's disease. Parenteral administration for DI in infants under 3 months and intranasal administration in infants less than 11 months. Nephrogenic DI, polyuria due to psychogenic DI, renal disease, hypercalcemia, hyperkalemia, or administration of demeclocycline or lithium.

Special Concerns: Safety for use during lactation not established. Use with caution and with restricted fluid intake in infants due to an increased risk of hyponatremia and water intoxication. Geriatric clients may have a greater risk of developing hyponatremia and water intoxication. Use with caution in clients with coronary artery insufficiency and/or hypertensive CV disease. Use cautiously with other pressor agents. Safety and efficacy have not been determined in children less than 12 years of age (parenteral) or less than 2 months of age (intranasal) with DI.

Side Effects: DDAVP: Intranasal: Transient headaches, nausea, nasal congestion, rhinitis, facial flushing, asthenia, chills, conjunctivitis, cough, dizziness, epistaxis, eye edema, GI disorder, lacrimation, nosebleed, nostril pain, sore throat, URIs. Parenteral: Mild abdominal pain, facial flushing, transient headache, nausea, vulval pain, BP changes, burning pain, edema, local erythema, anaphylaxis (rare).
Stimate: I ntranasal: Agitation, balanitis, chest pain, chills, dizziness, dyspepsia, edema, insomnia, itch or light-sensitive eyes, pain, palpitations, somnolence, tachycardia, vomiting, warm feeling.

Overdose Management: Symptoms: Headache, abdominal cramps, facial flushing, dyspnea, fluid retention, mucous membrane irritation. Treatment: Reduce dose, decrease frequency of administration, or withdraw the drug depending on the severity of the condition.

Drug Interactions: Chlorpropamide, clofibrate, and carbamazepine may potentiate desmopressin effects.

How Supplied: Injection: 4 mcg/mL, 15 mcg/mL; Solution: 0.01%; Spray: 0.01 mg/inh, 0.15 mg/inh; Tablet: 0.1 mg, 0.2 mg

Dosage
?SC, Direct IV Neurogenic DI.
Adults: 0.5-1 mL/day in two divided doses, adjusted separately for an adequate diurnal rhythm of water turnover. If switching from intranasal to IV, the comparable IV antidiuretic dose is about 1/10 the intranasal dose.
Hemophilia A, von Willebrand's disease (type I).
Adults: 0.0003 mg/kg diluted in 50 mL 0.9% NaCl injection infused IV over 15-30 min; dose may be repeated, if necessary. Pediatric, 3 months or older, weighing 10 kg or less, IV: 0.0003 mg/kg diluted in 10 mL of 0.9% NaCl injection and given over 15-30 min; repeat if necessary. Pediatric, 3 months or older, weighing 10 kg or more, IV: 0.0003 mg/kg diluted in 50 mL of 0.9% NaCl injection and given over 15-30 min; repeat if necessary.
?Intranasal Neurogenic DI.
Adults: 0.1-0.4 mL/day, either as a single dose or divided into two to three doses (usual: 0.2 mL/day in two divided doses). Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. Children, 3 months to 12 years: 0.05-0.3 mL/day, either as a single dose or two divided doses.
Nocturnal enuresis.
Age 6 years and older, initial: 0.02 mg (0.2 mL) at bedtime with one-half the dose in each nostril; if no response, the dose may be increased to 0.04 mg.
Hemophilia A and type I von Willenbrand's disease.
In clients weighing 50 kg or more: One spray per nostril (total dose of 300 mcg). In clients weighing less than 50 kg: Given as a single spray of 150 mcg. The drug may be given 2 hr prior to minor surgery in the same doses as described above.
Renal concentration capacity test.
Adults: 0.040 mg (0.020 mg in each nostril) given any time during the day. Children, 3-12 years: 0.020 mg given in the morning.
?Tablets Central cranial DI.
Adults, initial: 0.05 mg b.i.d.; adjust individually to optimum therapeutic dose and adjust each dose for an adequate diurnal rhythm of water turnover. Total daily dose should be increased or decreased (range 0.1-1.2 mg divided b.i.d.-t.i.d.) as needed to obtain adequate antidiuresis. Children, initial: 0.05 mg. Careful restriction of fluid intake in children is required to prevent hyponatremia and water intoxication.
Primary nocturnal enuresis.
Age 6 years and older, initial: 0.2 mg at bedtime. May be increased to 0.6 mg, depending on client response.