Dosing & Uses
Dosage Forms & Strengths
injectable solution (DDAVP)
- 4mcg/mL
tablet (DDAVP)
- 0.1mg
- 0.2mg
nasal spray (DDAVP, DDAVP Rhinal Tube)
- 0.1mg/mL (5mL): Delivers 10mcg/spray
nasal spray (Stimate)
- 1.5mg/mL (2.5mL): Delivers 150mcg/spray
preservative-free nasal spray (Noctiva)
- 0.83 mcg of desmopressin acetate/0.1mL (equivalent to 0.75 mcg desmopressin)
- 1.66 mcg of desmopressin acetate/0.1mL (equivalent to 1.5 mcg desmopressin)
tablet, sublingual (Nocdurna)
- 27.7mcg of desmopressin acetate (equivalent to 25 mcg of desmopressin)
- 55.3mcg of desmopressin acetate (equivalent to 50 mcg of desmopressin)
Diabetes Insipidus
Intranasal (DDAVP)
- Indicated as antidiuretic replacement therapy in the management of central cranial diabetes insipidus and for management of the temporary polyuria and polydipsia following head trauma or surgery
- 10-40 mcg (0.1-0.4 mL) qDay, either as a single dose or divided into 2 or 3 doses; usual dose is 20 mcg (0.2 mL) qDay in 2 divided doses
- Adjust morning and evening doses separately for an adequate 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
IV
- Indicated for patients with hemophilia A with factor VIII coagulant activity levels greater than 5%
- 0.3 mcg/kg IV over 15-30 minutes (for pre-op, 30 min before procedure)
Intranasal (Stimate)
- Indicated for patients with mild to moderate classic von Willebrand disease (Type I) with Factor VIII levels >5%
- <50 kg: 150 mcg; for pre-op, give 2 hr before procedure
- >50 kg: 300 mcg; for pre-op, give 2 hr before procedure
Von Willebrand Disease (Type 1)
IV
- Indicated for patients with mild to moderate classic von Willebrand’s disease (Type I) with factor VIII levels greater than 5%
- 0.3 mcg/kg IV over 15-30 minutes (for pre-op, 30 min before procedure)
Intranasal (Stimate)
- Indicated for patients with mild to moderate classic von Willebrand disease (Type I) with Factor VIII levels >5%
- <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)
Nocturia
Nocturnal polyuria was defined in clinical trials as nighttime urine production exceeding one-third of 24-hour urine production
Preservative-free nasal spray (Noctiva)
- Indicated for nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void
>50 to <65 years
- 1 spray of 1.66 mcg in either nostril nightly ~ 30 min before going to bed
≥65 years
- 0.83 mcg in either nostril nightly ~ 30 min before going to bed; 0.83 mcg dose may have a lower risk of hyponatremia; may be increased to 1 spray of 1.66 mcg after at least 7 days, if needed, provided serum sodium has remained normal
Sublingual tablets (Nocdurna)
- Indicated for nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void
- Before starting or resuming, assess the sodium concentration and only start or resume in patients with a normal serum sodium concentration
- Women: 27.7 mcg SL qDay, 1 hr before bedtime, administered SL without water
- Men: 55.3 mcg SL qDay, 1 hr before bedtime, administered SL without water
- Also see Administration and Dosing Consideration
Uremic Bleeding in Acute or Chronic Renal Failure
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
Dosing Considerations
Switching between desmopressin formulations
- Switching from injection to nasal spray: Administer 10x the amount of desmopressin acetate, rounding down to the nearest 10 mcg
- Switching from tablets to nasal spray: Individual dose titration is required because intranasal desmopressin is ~10 to 40-fold more potent than oral (tablet) desmopressin
Sublingual tablets and preservative-free nasal spray
- Sublingual tab only: Recommended dose for women is lower than for men due to women being more sensitive to the effects of the sublingual tablets and having a higher risk of hyponatremia with the 55.3 mcg dose in clinical trials
Before starting treatment
- Evaluate patient for possible causes for the nocturia, including excessive fluid intake prior to bedtime, and address other treatable causes of nocturia
- Confirm diagnosis of nocturnal polyuria with a 24-hr urine collection, if not obtained previously
Sodium monitoring
- Ensure serum sodium concentration is normal prior to initiating or resuming treatment Contraindicated in patients with hyponatremia or a history of hyponatremia (see Contraindications)
- Check serum sodium concentration within the first week and again at 1 month after initiating or resuming therapy
- Periodically monitor serum sodium during therapy, as clinically appropriate; closely monitor patients ≥65 years and patients at risk of hyponatremia
- If patient develops hyponatremia, consider temporarily or permanently discontinuing therapy, and institute treatment for hyponatremia, depending on the clinical circumstances, including the duration and severity of the hyponatremia
Limitations of use
- Stimate: Not to be used in patients with Type IIB von Willebrand's disease since platelet aggregation may be induced
- Noctiva: Not studied in patients <50 years
Nasal spray
- Treatment of nephrogenic diabetes insipidus or primary nocturnal enuresis
- Use in patients with conditions that compromise the intranasal route of administration (eg, severe nasal congestion and blockage, nasal mucosa atrophy, severe atrophic rhinitis, recent nasal surgery such as transsphenoidal hypophysectomy)
- Use in patients with an impaired level of consciousness Use in patients requiring doses <10 mcg or doses that are not multiples of 10 mcg
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
Diabetes Insipidus
Nasal spray
- Indicated as antidiuretic replacement therapy in the management of central cranial diabetes insipidus and for management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region in patients (>3 months)
- <3 months: Safety and efficacy not established
3 months-12 years
- Usual dosage range is 5-30 mcg (0.05-0.3 mL) qDay, either as a single dose or divided into 2 doses
- About 1/4 to 1/3 of patients can be controlled by a single daily dose of DDAVP administered intranasally
- Adjust doses separately for appropriate diurnal rhythm of water turnover if administering more than once a day
>12 years
- 10-40 mcg (0.1-0.4 mL) qDay, either as a single dose or divided into 2 or 3 doses; usual dose is 20 mcg (0.2 mL) qDay in 2 divided doses
- Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover
Nocturnal Enuresis
>6 years: 0.2 mg PO qHS (up to 0.6 mg/day)
Hemophilia A & Von Willebrand Disease
Indicated for patients with hemophilia A or von Willebrand disease (type 1) with Factor VIII coagulant activity levels >5%; will also stop bleeding in patients with episodes of spontaneous or trauma-induced injuries (eg, hemarthroses, intramuscular hematomas, mucosal bleeding)
IV
Infants ≥3 months, children, and adolescents
- 0.3 mcg/kg IV
- If used preoperatively, administer 30 min before procedure
- May repeat dose if needed
Intranasal (Stimate)
Infants ≥11 months, children, and adolescents
- <50 kg: 150 mcg intranasally
- ≥50 kg: 300 mcg intranasally If used preoperatively, administer 2 hr before procedure
Fluid intake should be limited 1 hr prior to dose until the next morning or at least 8 hr after administration
Repeat use determined by clinical symptoms and laboratory values
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
Dosing Considerations
Switching between desmopressin formulations
- Switching from injection to nasal spray: Administer 10x the amount of desmopressin acetate, rounding down to the nearest 10 mcg
- Switching from tablets to nasal spray: Individual dose titration is required because intranasal desmopressin is ~10 to 40-fold more potent than oral (tablet) desmopressin
Sublingual tablets and preservative-free nasal spray
- Sublingual tab only: Recommended dose for women is lower than for men due to women being more sensitive to the effects of the sublingual tablets and having a higher risk of hyponatremia with the 55.3 mcg dose in clinical trials
Before starting treatment
- Evaluate patient for possible causes for the nocturia, including excessive fluid intake prior to bedtime, and address other treatable causes of nocturia
- Confirm diagnosis of nocturnal polyuria with a 24-hr urine collection, if not obtained previously
Sodium monitoring
- Ensure serum sodium concentration is normal prior to initiating or resuming treatment Contraindicated in patients with hyponatremia or a history of hyponatremia (see Contraindications)
- Check serum sodium concentration within the first week and again at 1 month after initiating or resuming therapy
- Periodically monitor serum sodium during therapy, as clinically appropriate; closely monitor patients ≥65 years and patients at risk of hyponatremia
- If patient develops hyponatremia, consider temporarily or permanently discontinuing therapy, and institute treatment for hyponatremia, depending on the clinical circumstances, including the duration and severity of the hyponatremia
Limitations of use
- Stimate: Not to be used in patients with Type IIB von Willebrand's disease since platelet aggregation may be induced
- Noctiva: Not studied in patients <50 years
Nasal spray
- Treatment of nephrogenic diabetes insipidus or primary nocturnal enuresis
- Use in patients with conditions that compromise the intranasal route of administration (eg, severe nasal congestion and blockage, nasal mucosa atrophy, severe atrophic rhinitis, recent nasal surgery such as transsphenoidal hypophysectomy)
- Use in patients with an impaired level of consciousness
- Use in patients requiring doses <10 mcg or doses that are not multiples of 10 mcg
Nocturia
Nocturnal polyuria was defined in clinical trials as nighttime urine production exceeding one-third of 24-hour urine production
Indicated for treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void; nocturnal polyuria was defined in clinical trials as night-time urine production exceeding one-third of 24-hr urine production
Preservative-free nasal spray (Noctiva)
≥65 years: 0.83 mcg in either nostril ~ 30 min before going to bed; 0.83 mcg dose may have lower risk of hyponatremia; may be increased to 1 spray of 1.66 mcg after at least 7 days, if needed, provided serum sodium has remained normal
Sublingual tablets
A total of 562 subjects 65 years or older were enrolled in the clinical trials, ~48% of the study population
Clinical studies of desmopressin have shown an increased risk of hyponatremia in patients ≥65 years compared to those <65 years
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- mometasone, intranasal
mometasone, intranasal increases toxicity of desmopressin by Other (see comment). Contraindicated. Comment: Increases risk of severe hyponatremia.
Serious - Use Alternative (1)
- mometasone inhaled
mometasone inhaled increases toxicity of desmopressin by Other (see comment). Avoid or Use Alternate Drug. Comment: Corticosteroids may enhance the hyponatremic effect of intranasal desmopressin.
Monitor Closely (2)
- methylphenidate transdermal
methylphenidate transdermal and desmopressin both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- trametinib
desmopressin increases toxicity of trametinib by unknown mechanism. Use Caution/Monitor. Decreased desmopressin dose requirements were noted in 2 young patients with cranial diabetes insipidus in whom trametinib was used concurrently with desmopressin.
Minor (28)
- benzphetamine
desmopressin increases effects of benzphetamine by pharmacodynamic synergism. Minor/Significance Unknown.
- carbamazepine
carbamazepine, desmopressin. Mechanism: unknown. Minor/Significance Unknown. Carbamazepine may increase or decrease the duration of action of desmopressin.
- chlorpropamide
chlorpropamide increases effects of desmopressin by pharmacodynamic synergism. Minor/Significance Unknown.
- dexfenfluramine
desmopressin increases effects of dexfenfluramine by pharmacodynamic synergism. Minor/Significance Unknown.
- dexmethylphenidate
desmopressin increases effects of dexmethylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.
- dextroamphetamine
desmopressin increases effects of dextroamphetamine by pharmacodynamic synergism. Minor/Significance Unknown.
- diethylpropion
desmopressin increases effects of diethylpropion by pharmacodynamic synergism. Minor/Significance Unknown.
- dobutamine
desmopressin increases effects of dobutamine by pharmacodynamic synergism. Minor/Significance Unknown.
- dopamine
desmopressin increases effects of dopamine by pharmacodynamic synergism. Minor/Significance Unknown.
- ephedrine
desmopressin increases effects of ephedrine by pharmacodynamic synergism. Minor/Significance Unknown.
- epinephrine
desmopressin increases effects of epinephrine by pharmacodynamic synergism. Minor/Significance Unknown.
- fenfluramine
desmopressin increases effects of fenfluramine by pharmacodynamic synergism. Minor/Significance Unknown.
- isoproterenol
desmopressin increases effects of isoproterenol by pharmacodynamic synergism. Minor/Significance Unknown.
- lisdexamfetamine
desmopressin increases effects of lisdexamfetamine by pharmacodynamic synergism. Minor/Significance Unknown.
- methamphetamine
desmopressin increases effects of methamphetamine by pharmacodynamic synergism. Minor/Significance Unknown.
- methylenedioxymethamphetamine
desmopressin increases effects of methylenedioxymethamphetamine by pharmacodynamic synergism. Minor/Significance Unknown.
- methylphenidate
desmopressin increases effects of methylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.
- midodrine
desmopressin increases effects of midodrine by pharmacodynamic synergism. Minor/Significance Unknown.
- norepinephrine
desmopressin increases effects of norepinephrine by pharmacodynamic synergism. Minor/Significance Unknown.
- phendimetrazine
desmopressin increases effects of phendimetrazine by pharmacodynamic synergism. Minor/Significance Unknown.
- phentermine
desmopressin increases effects of phentermine by pharmacodynamic synergism. Minor/Significance Unknown.
- phenylephrine
desmopressin increases effects of phenylephrine by pharmacodynamic synergism. Minor/Significance Unknown.
- phenylephrine PO
desmopressin increases effects of phenylephrine PO by pharmacodynamic synergism. Minor/Significance Unknown.
- propylhexedrine
desmopressin increases effects of propylhexedrine by pharmacodynamic synergism. Minor/Significance Unknown.
- pseudoephedrine
desmopressin increases effects of pseudoephedrine by pharmacodynamic synergism. Minor/Significance Unknown.
- serdexmethylphenidate/dexmethylphenidate
desmopressin increases effects of serdexmethylphenidate/dexmethylphenidate by pharmacodynamic synergism. Minor/Significance Unknown.
- xylometazoline
desmopressin increases effects of xylometazoline by pharmacodynamic synergism. Minor/Significance Unknown.
- yohimbine
desmopressin increases effects of yohimbine by pharmacodynamic synergism. Minor/Significance Unknown.
Adverse Effects
>10%
Nocdurna
- Dry mouth, men (14%)
- Dry mouth, women (12%)
1-10%
Nocdurna
- Headache (2-5%)
- Hyponatremia, men (4%)
- Headache, men (4%)
- Hyponatremia, women (3%)
- Dizziness, men (3%)
- Dizziness (3%)
- Epistaxis (2-3%)
- Headache, women (2%)
- Dizziness, women (2%)
Nasal spray
- Rhinitis (3-8%)
- Abdominal pain (2%)
- Asthenia (2%)
- Chills (2%)
- Nostril pain (2%)
- Gastrointestinal disorder (2%)
- Nausea (2%)
- Conjunctivitis (2%)
- Eye edema (2%)
- Lachrymation 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)
Noctiva
- Nasal discomfort
- Nasal congestion
- Atrial fibrillation
- Dizziness
- Dyuria
Warnings
Black Box Warnings
Hyponatremia
Intranasal preservative-free (Noctiva) and sublingual tablets
- Hyponatremia may occur; severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest, or death
- Contraindicated in patients at increased risk of severe hyponatremia, such as patients with excessive fluid intake, illnesses that can cause fluid or electrolyte imbalances, and in those using loop diuretics or systemic or inhaled glucocorticoids
- Ensure serum sodium is normal before starting or resuming therapy; measure serum sodium within 7 days and approximately 1 month after initiating therapy or increasing dose, and periodically during treatment; monitor serum sodium frequently in patients >65 years and patients at increased risk of hyponatremia
- If hyponatremia occurs, therapy may need to be temporarily or permanently discontinued
Contraindications
Hypersensitivity
Hyponatremia or history of hyponatremia
Moderate to severe renal impairment (CrCl <50 mL/min)
Intranasal preservative-free (Noctiva) and sublingual tablets
- Polydipsia
- Primary nocturnal enuresis
- Concomitant use with loop diuretics or systemic or inhaled glucocorticoids
- Estimated glomerular filtration rate below 50 mL/min/1.73 m²
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Uncontrolled hypertension
- During illnesses that can cause fluid or electrolyte imbalance
- Noctiva only: New York Heart Association (NYHA) class II-IV congestive heart failure
- Nocdurna only: Heart failure
Cautions
Factor VIII levels <5% or presence of factor VIII antibodies
Avoid use in Type IIB von Willebrand disease
Therapeutic effect has not been observed in patients who have been febrile or stressed for several days; monitor for efficacy if necessary
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
Anaphylactic reactioins reported (rare) with IV and intranasal administration
Use alternative route of administration if changes in the nasal mucosa resulting from edema or scarring occurs
Rapid IV infusions may result in severe hypotension
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
Therapy can cause fluid retention, which can worsen underlying conditions that are susceptible to volume status, including congestive heart failure (see Contraindications)
In children and the elderly adjust fluid intake downward to decrease possibility of water intoxication and hyponatremia
Nasal spray
- Chronic administration nasal spray may result in changes to nasal mucosa; nasal mucosa abnormalities (such as scarring and edema) due to chronic administration, or due to other causes (nasal blockage, nasal mucosal atrophy, severe atrophic rhinitis, recent nasal surgery such as transsphenoidal hypophysectomy) may cause erratic, unreliable absorption; avoid use of nasal spray in such patients and consider use of other formulations of desmopressin acetate given by other routes of administration
- Intranasal DDAVP at high dosage has infrequently produced a slight elevation of blood pressure, which disappeared with a reduced dose; exercise caution in patients with coronary artery insufficiency and/or hypertensive cardiovascular disease because of possible rise in blood pressure
- Use with caution in patients predisposed to thrombus formation; acute myocardial infarction and cerebrovascular thrombosis reported with desmopressin injection
Noctiva only
- Before starting or resuming therapy, ensure that serum sodium concentration is normal; consider 0.83-mcg dose as starting dose for patients who may be at risk for hyponatremia
- Not recommended in patients at risk of increased intracranial pressure or history of urinary retention; monitor volume status in patients with NYHA class I congestive heart failure
- Discontinue therapy in patients with concurrent nasal conditions that may increase systemic absorption (eg, atrophy of nasal mucosa, acute or chronic rhinitis), because increased absorption may increase risk of hyponatremia; therapy can be resumed when conditions resolve
- When therapy is administered, fluid intake in the evening and nighttime hours should be moderated to decrease risk of hyponatremia; monitor serum sodium concentration within 7 days and ~1 month of initiating therapy or increasing dose, and periodically thereafter; the frequency of serum sodium monitoring should be based on patient’s risk for hyponatremia
Hyponatremia
- Also see Administration, Black Box Warnings, and Dosing Considerations
- In order to decrease risk of water intoxication with hyponatremia, fluid restriction recommended; careful fluid intake restriction is particularly important in pediatric and geriatric patients because these patients are at greater risk of developing hyponatremia; more frequent monitoring of serum sodium levels recommended in the following patients: those with conditions associated with fluid and electrolyte imbalance, such as cystic fibrosis, heart failure, renal disorders, habitual or psychogenic polydipsia or those taking concomitant drugs that may cause hyponatremia
- Nasal spray is not an indicated formulation for treatment of primary nocturnal enuresis due to higher risk of hyponatremia and hyponatremic convulsions with use of nasal spray formulation compared to desmopressin tablets seen in postmarketing reports
- Signs and symptoms associated with hyponatremia: Headache, nausea/vomiting, decreased serum sodium, weight gain, restlessness, fatigue, lethargy, disorientation, depressed reflexes, loss appetite, irritability, muscle weakness, muscle spasms or cramps and abnormal mental status such as hallucinations, decreased consciousness, and confusion
- Severe symptoms due to an extreme decrease in serum sodium and plasma osmolality may include one or a combination of the following: seizure, coma, and/or respiratory arrest
Drug interaction overview
- Concomitant use of desmopressin sublingual and loop diuretics or systemic or inhaled glucocorticoids is contraindicated because of the risk of severe hyponatremia; may be started or resumed 3 days or 5 half-lives after discontinuing glucocorticoid, whichever is longer
- Drugs (eg, tricyclic antidepressants, selective serotonin reuptake inhibitors, chlorpromazine, opiate analgesics, thiazide diuretics, carbamazepine, lamotrigine, sulfonylureas, particularly chlorpropamide, NSAIDs) may increase the risk of hyponatremia; monitor serum sodium more frequently in patients taking desmopressin concomitantly with these drugs and when doses of these drugs are increased
- Use of large doses of nasal spray with other vasoconstrictors may require reducing the dose
Pregnancy & Lactation
Pregnancy
Prolonged experience with desmopressin in pregnant women over several decades, based on available published data and case reports, did not identify a drug associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes; in addition, in vitro studies with human placenta demonstrate poor placental transfer of desmopressin; no adverse developmental outcomes were observed in animal reproduction studies with administration of desmopressin during organogenesis to pregnant rats and rabbits at doses approximately <1 and 38 times, respectively, the maximum recommended human dose based on body surface area (mg/m²)
Not recommended for treatment of nocturia in pregnant women; nocturia is usually related to normal, physiologic changes during pregnancy that do not require treatment
Animal data
- No adverse developmental outcomes were observed in animal reproduction studies with administration of desmopressin during organogenesis to pregnant rats and rabbits at doses approximately <1 and 38 times, respectively, the maximum recommended human dose based on body surface area
- No adverse developmental outcomes were observed in animal reproductive and developmental studies following administration of desmopressin acetate during organogenesis to pregnant rats and rabbits, at exposures 92- and 8- times, respectively, the maximum recommended dose in women, based on body surface area
Lactation
Desmopressin is present in small amounts in human milk and is poorly absorbed orally by infant
There is no information on effects of desmopressin on breastfed infant or on milk production; development and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and potential adverse effects on breastfed infant from therapy or from the underlying maternal condition
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.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
Antidiuretic effects of desmopressin are mediated by stimulation of vasopressin 2 (V2) receptors, thereby increasing water re-absorption in the kidneys, and reducing urine production
Absorption
Bioavailability: 3.3-4.1% (Stimate); 3.5% (nasal); 5% (oral; compared to intranasal, 0.16% compared to IV); 0.25 (SL)
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); 0.25 hr for 0.83 mcg dose and 0.75 hr for 1.66 mcg dose (preservative-free nasal spray)
Distribution
Vd: 26.5 L (IV)
Metabolism
Unknown
Elimination
Half-life: 3.3-3.5 hr (intranasal); 3 hr (IV, healthy patient); 9 hr (IV, severe renal impairment); 2-3 hr (PO); 2.8 hr (1.66 mcg dose; preservative-free nasal spray): 2.8 hr (SL)
Excretion (IV): Urine (52%)
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
Intranasal Administration
Only administer intranasally; do not shake bottle
If dose is missed, do not double dose at next use
If spray pump is not used for 2 week (DDAVP or Minirin) or 1 week (Stimate), reprime pump by pressing down on the pump once
Discard after 50 sprays (DDAVP or Minirin) or 25 sprays (Stimate) since the amount delivered thereafter may be substantially less than the recommended dosage
Ensure that in children administration is under adult supervision in order to control the dose intake
Intranasal preservative-free (Noctiva)
- Prime with 5 actuations before initial use; re-prime with 2 actuations if not used for more than 3 days
- Two sprays of 0.83 mcg are not interchangeable with one spray of 1.66 mcg; nasal spray of 1.66 mcg/0.1 mL bottle for patients who are or will be taking 1.66 mcg dose
Oral Administration
Sublingual tablets
- Place 1 tablet under the tongue 1 hr before bedtime and to empty their bladder immediately prior to bedtime
- Tablet should remain under the tongue until it dissolves
- Advise patients to limit fluid intake to a minimum starting 1 hr prior to administration and for 8 hr following administration
- Avoid caffeine and alcohol before bedtime
Storage
Injection: Refrigerate between 2-8°C (36-46°F)
Sublingual tablets: Store at controlled 20-25°C (68-77°F); excursions permitted between 15-30°C (59-86°F); keep in original package to protect from moisture and light; use immediately upon opening individual tablet blister
Intranasal products
DDAVP, Minirin
- Store at controlled room temperature 20-25°C (68-77°F) in upright position
- Discard after 50 sprays since the amount delivered thereafter per spray may be substantially less than 10 mcg of drug
Stimate
- Store at 25°C (77°F) in upright position
- Discard after 25 sprays since the amount delivered thereafter per spray may be substantially less
- Stimate: Discard 6 months after opening
Noctiva
- Before opening, store upright in a refrigerator, 2-8°C (36-46°F); excursion permitted between 0°C and 15°C (32°F and 59°F)
- After opening, store upright at room temperature 20-25ºC (68-77ºF)
- Discard 60 days after opening
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| DDAVP injection - | 4 mcg/mL vial |  | |
| DDAVP injection - | 4 mcg/mL solution |  | |
| desmopressin injection - | 4 mcg/mL vial |  | |
| desmopressin injection - | 4 mcg/mL vial |  | |
| desmopressin injection - | 4 mcg/mL vial |  | |
| desmopressin injection - | 4 mcg/mL solution |  | |
| desmopressin injection - | 4 mcg/mL solution |  | |
| desmopressin injection - | 4 mcg/mL vial |  | |
| desmopressin injection - | 4 mcg/mL vial |  | |
| desmopressin injection - | 4 mcg/mL vial |  | |
| desmopressin injection - | 4 mcg/mL vial |  | |
| DDAVP oral - | 0.2 mg tablet |  | |
| DDAVP oral - | 0.1 mg tablet |  | |
| desmopressin oral - | 0.2 mg tablet |  | |
| desmopressin oral - | 0.2 mg tablet |  | |
| desmopressin oral - | 0.1 mg tablet |  | |
| desmopressin oral - | 0.1 mg tablet |  | |
| desmopressin oral - | 0.2 mg tablet |  | |
| desmopressin oral - | 0.1 mg tablet |  | |
| desmopressin oral - | 0.2 mg tablet |  | |
| desmopressin oral - | 0.1 mg tablet |  | |
| desmopressin oral - | 0.2 mg tablet |  | |
| desmopressin oral - | 0.1 mg tablet |  | |
| desmopressin oral - | 0.2 mg tablet | | |
| desmopressin oral - | 0.1 mg tablet |  | |
| desmopressin oral - | 0.1 mg tablet |  | |
| desmopressin nasal - | 10 mcg/spray (0.1 mL) aerosol |  | |
| desmopressin nasal - | 10 mcg/spray (0.1 mL) aerosol |  | |
| desmopressin nasal - | 10 mcg/spray (0.1 mL) aerosol |  | |
| desmopressin nasal - | 10 mcg/spray (0.1 mL) aerosol |  | |
| Noctiva nasal - | 1.66 mcg/spray (0.1 mL) aerosol |  | |
| Noctiva nasal - | 0.83 mcg/spray (0.1 mL) aerosol |  |
Copyright © 2010 First DataBank, Inc.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
