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desmopressin (Rx)Brand and Other Names:DDAVP, Stimate, more...Minirin

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 4mcg/mL

tablet

  • 0.1mg
  • 0.2mg

nasal spray

  • 0.1mg/mL (5mL): Delivers 10mcg/spray
  • 1.5mg/mL (2.5mL): Delivers 150mcg/spray
more...

Diabetes Insipidus

Intranasal (DDAVP)

  • 10-40 mcg/day qDay or divided q8-12hr
  • Adjust morning and evening doses separately for appropriate diurnal rhythm of water turnover

PO

  • Initial: 0.05 mg q12hr
  • Effective range: 0.1-1.2 mg divided q8-12hr
  • Observe fluid restriction
  • If switching to PO from intranasal, start PO at least 12 hours after last intranasal dose

IV/SC

  • 2-4 mcg/day divided q12hr or one-tenth the maintenance of intranasal dose

Hemophilia A & Von Willebrand Disease

Hemophilia with factor VIII levels greater than 5%; von Willebrand disease (type I)

0.3 mcg/kg IV over 15-30 minutes IV (for pre-op, 30 min before procedure) 

Intranasal (Stimate)

  • <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

Primary nocturnal enuresis (not intranasal)

0.2 mg PO qHS (up to 0.6 mg/day)

Uremic Bleeding in Acute or Chronic Renal Failure

0.4 mcg/kg IV over 10 minutes 

Dosing Modifications

Renal impairment

  • CrCl <50 mL/min: Contraindicated; has been used unlabeled in acute and chronic renal failure patients experiencing uremic bleeding or prevention of surgical bleeding
  • CrCl ≥50 mL/min: No adjustments necessary

Dosage Forms & Strengths

injectable solution

  • 4mcg/mL

tablet

  • 0.1mg
  • 0.2mg

nasal spray

  • 0.1mg/mL (5mL): Delivers 10mcg/spray
  • 1.5mg/mL (2.5mL): Delivers 150mcg/spray
more...

Diabetes Insipidus

3 months to 12 years (intranasal)

  • 5-30 mcg/day qDay or divided q12hr (using 100 mcg/mL solution)

>12 years (intranasal)

  • 10-40 mcg/day qDay/divided q12hr intranasal (using 100 mcg/mL solution)

3 months to 12 years (oral)

  • Initial: 0.05 mg PO q12hr
  • Effective range: 0.1-1.2 mg
  • If switching to PO from intranasal, start PO at least 12 hours after last intranasal dose

>12 years (oral)

  • Initial: 0.05 mg PO q12hr
  • Effective range: 0.1-1.2 mg divided q8-12hr
  • Observe fluid restriction
  • If switching to PO from intranasal, start PO at least 12 hours after last intranasal dose

IV or SC administration

3 months to 12 years (IV/SC)

  • 0.1-1 mcg qDay or divided q12hr
  • Initiate at low dose and increase as necessary
  • Monitor serum sodium levels and urine output

>12 years (IV/SC)

  • 2-4 mcg/day divided q12hr or one tenth the maintenance of intranasal dose

Nocturnal Enuresis

>6 years: 0.2 mg PO qHS (up to 0.6 mg/day)

Hemophilia A & Von Willebrand Disease

0.3 mcg/kg IV over 15-30 minutes; for preop, 30 minutes before procedure 

1 spray (150 mcg) per nostril (300 mcg total dose) if >12 year of age or >50 kg body weight; administer a 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

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Interactions

Interaction Checker

desmopressin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
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            Adverse Effects

            1-10%

            Headache (2-5%)

            GI disorder (2%)

            Fatigue (10%)

            Abdominal pain (2%)

            Nausea (2%)

            Rhinitis (3-8%)

            Conjunctivitis (2%)

            Edema eyes (2%)

            Lacrimation disorder (2%)

            Frequency Not Defined

            Abnormal blood pressure (infrequent)

            Increased heart rate

            Increased blood pressure

            Flushing

            Seizure (rare)

            Hyponatremia

            Hyposmolality (rare)

            Water intoxication syndrome

            Thromboembolic disorder

            Allergic reaction (acute)

            Anaphylaxis (rare)

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            Warnings

            Contraindications

            Hypersensitivity

            Hyponatremia or history of hyponatremia

            Moderate to severe renal impairment (CrCl <50 mL/min)

            Cautions

            Hypertension

            Avoid desmopressin injections in children <3 months with hemophilia A or von Willebrand disease

            Coronary artery insufficiency

            Fluid and electrolyte imbalance

            Factor VIII levels <5% or presence of factor VIII antibodies

            Avoid use in Type IIB von Willebrand disease

            Use caution in patients with habitual or psychogenic polydipsia (increased risk of hypnatremia)

            Risk of potentially fatal hyponatremia/seizures; may occur with any route of administration

            Use alternative route of administration if changes in the nasal mucosa resulting from edema or scarring occurs

            Patients should be asked to restrict fluid intake from 1 hr before to 8 hr after taking desmopressin tablets; consider alternate route (IV) if therapeutic response inadequate at maximum recommended oral dose

            Interrupt therapy if patient perform activities associated with increase in water consumption or with acute illness including fever or recurrent vomiting or diarrhea

            Use with caution in patients predisposed to thrombus formation; acute myocardial infarction and cerebrovascular thrombosis reported with desmopressin injection

            In children and the elderly adjust fluid intake downward to decrease possibility of water intoxication and hyponatremia

            Signs and symptoms associated with hyponatremia

            • Headache
            • Nausea/vomiting
            • Decreased serum sodium
            • Weight gain
            • Restlessness
            • Fatigue
            • Lethargy
            • Disorientation
            • Depressed reflexes
            • Loss of appetite
            • Irritability
            • Muscle weakness
            • Muscle spasms or cramps
            • Abnormal mental status (eg, hallucinations), decreased consciousness, and confusion
            • Severe symptoms may include seizure, coma, and/or respiratory arrest
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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Distributed into breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Synthetic analogue of vasopressin with prompt onset and longer, more specific antidiuretic action; desmopressin increases water permeability in renal tubular cells, which in turn decreases urine volume and increases urine osmolality

            Also produces dose-related increase in von Willebrand factor VIII and t-PA levels; this shortens activated partial thromboplastin time (aPTT), as well as bleeding time

            Absorption

            Bioavailability: 3.5% (nasal); 5% (oral; compared to intranasal, 0.16% compared to IV)

            Onset: ADH effect (intranasal), 60 min; hemophilia and von Willebrand disease (IV), 30 min

            Duration: 6-14 hr (intranasal, IV infusion, oral)

            Peak plasma time: 1-5 hr (intranasal)

            Metabolism

            Unknown

            Elimination

            Half-life: 3.5 hr (intranasal); 3 hr (IV); 2-3 hr (PO)

            Excretion: Urine

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            Administration

            IV Administration

            Dilute appropriate dose in 10 mL NS for children <10 kg or 50 mL NS for adults and children >10 kg

            Infuse slowly over 15-30 min

            Monitor blood pressure and pulse during infusion

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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