administer single spray (150 mcg) if patient >12 years of age but <50 kg body weight. Desmopressin acetate 200 microgram tablets; 10microgram/mL WCHN prepared solution; 4microgram/mL injection solution - SA Neonatal Medication Guidelines | SA Health Medication guideline for the management of neonates requiring desmopressin acetate. Limit fluid intake to a minimum 1 hour before and 8 hours after administration. Dilute DDAVP Injection in sterile 0.9% Sodium Chloride Injection, USP and infuse slowly over 15 minutes to 30 minutes. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA. *Ovv]pu}gz$3 (Synthetic analog of vasopressin-posterior pituitary hormone). Although the manufacturer states that nasal congestion does not affect the absorption of intranasal desmopressin, some clinicians recommend a higher dose. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Adjust dose based upon response to treatment estimated by two parameters: adequate duration of sleep and adequate, not excessive, water turnover. 1 to 2 mcg IV twice a day or When switching from DDAVP Tablets to DDAVP Injection, titrate dose individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) due to the large variability in both PK and PD. In this study, efficacy and side effects of oral desmopressin. government site. Atenolol; Chlorthalidone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Most patients require a maintenance dose of 20 mcg/day, administered as 10 mcg intranasally twice daily. Patients receiving intranasal treatment could begin oral therapy the night following (24 hours) the last intranasal dose. Provide short term protection for uremic hemorrhagic tendency: 0.3 mcg/kg ivpb q8h x 2 doses (diminishing response). Desmopressin is present in small amounts in human milk and is poorly absorbed by an infant. Urea: (Minor) The manufacturer notes that the antidiuretic effect of desmopressin can be enhanced by the concomitant administration of urea. THOSE AT INCREASED RISK FOR HYPONATREMIA: 1 spray (0.83 mcg) in either the left or right nostril approximately 30 minutes before going to bed. 8600 Rockville Pike 1990 Aug;66(2):175-6 After oral desmopressin, concentrations above the limit of quantification (2.5 pg/ml) were only detected in 51% of the samples. Patients changing from intranasal desmopressin: The recommended starting dose of DDAVP Injection is 1/10th the daily maintenance intranasal dose administered by subcutaneous or intravenous injection as one or two divided doses. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Ensure the patient is compliant with fluid restrictions and intake. Further hospitalization cost saving may be achieved through reduced Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Interrupt therapy for acute illness (e.g., systemic infection, fever, recurrent vomiting or diarrhea), extremely hot weather, vigorous exercise, or other conditions associated with increased water intake. Infants 3 months of age and children: As of 2007 in response to a FDA request for removal of the indication, the intranasal formulation is no longer indicated for the treatment of primary nocturnal enuresis secondary to post-marketing reports of hyponatremic-related seizures, which most often occurred in pediatric patients. After at least 7 days of treatment, the dose may be increased to 1.66 mcg, if needed, provided the serum sodium is within the normal range during treatment with the 0.83 mcg dose. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Pediatric Pharmacology of Desmopressin in Children with Enuresis: A Comprehensive Review. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Cisplatin can cause hyponatremia, which may increase the risk of water intoxication in patients receiving treatment with desmopressin. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Ibuprofen; Famotidine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Celecoxib; Tramadol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. This medication helps to control increased thirst and too much urination due to these conditions . National Library of Medicine The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Twist off the seal from the dropper. However, individualized dosing is recommended due to high inter-patient variability in response. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. more than 50 kg: 150 mcg in each nostril. Repeat administration should be determined by laboratory response and clinical condition of the patient. A woman who took both desmopressin and ibuprofen was found in a comatose state. Desmopressin should be avoided in women with preeclampsia and those with cardiovascular disease due to the fact that oxytocin and IV fluids are often used during labor and delivery, both of which increase the risk of desmopressin-induced hyponatremia. IV: 0.3 mcg/kg once slowly over 15-30 minutes. Direct intravenous injectionNo dilution necessary.Inject IV over 1 minute. Administration of intranasal desmopressin may be compromised by nasal mucosa changes (e.g., nasal trauma, nasal surgery, nasal blockage, nasal mucosal atrophy, congestion, or severe atrophic rhinitis), cranial surgery, and nasal packing. Response to vasopressin is mediated through two receptors: the V1 receptor, which mediates smooth muscle contraction in the peripheral vasculature, and the V2 receptor, which regulates water resorption in the collecting ducts. Desmopressin is in a class of medications called hormones. If 30 mcg is divided, typically 20 mcg is given in the morning, and 10 mcg is given at night. Caution should be used when coadministering these agents. Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. IV injection due to hypotension, bradycardia, and arrhythmias. administration route. Monitor blood pressure during desmopressin administration, particularly in persons with coronary artery disease (insufficiency) and/or hypertension; desmopressin may cause hypotension (with compensatory increase in heart rate) or hypertension. A woman who took both desmopressin and ibuprofen was found in a comatose state. [61810], Initially, 5 mcg (0.05 mL) intranasally, given in 1 to 2 divided doses, then titrated to response. endobj
Caution should be used when coadministering these agents. Fluticasone; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. PLEASE READ THE. Budesonide; Formoterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. DDAVP Nasal SprayDDAVP nasal spray delivers doses in 0.1 mL (10 mcg) increments. Desmopressin is a strong V2 agonist and has no effect on V1 receptors. Treatment has been given safely to pediatric patients for up to 6 months. 1/10 of intranasal dose . It is postulated that desmopressin-induced increases in FVIII and vWF are mediated through low-affinity, extrarenal V2 receptors. HOW SUPPLIED Desmopressin Acetate Injection 4 mcg/mL is available as a clear colorless sterile solution as follows: Ampul - 4 mcg/mL - 1 mL - 10 per Box. IN 1977 DESMOPRESSIN (1-deamino-8-D-arginine vasopressin, abbreviated DDAVP), a derivative of the antidiuretic hormone, was used for the first time to treat patients with hemophilia A and von Willebrand disease (vWD), the most frequent congenital bleeding disorders. Adjust dose based upon response to treatment estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. May repeat dose if needed. Bendroflumethiazide; Nadolol: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. When switching between formulations, the below text is meant as guidance for starting dose. Bupivacaine; Meloxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Most patients respond to 1 to 2 doses; administer a second dose 8 to 24 hours after the first dose if needed. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The antidiuretic effects of the drug last for about 5 to 21 hours, followed by an abrupt cessation of activity that occurs over a 60- to 90-minute period. Loop diuretics: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. The https:// ensures that you are connecting to the Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. <>/Metadata 2732 0 R/ViewerPreferences 2733 0 R>>
If used preoperatively, administer 2 hours before surgery. Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. IV: 0.3 mcg/kg by slow infusion over 15 to 30 minutes beginning 30 minutes before procedure. Do not use desmopressin as sole therapy in persons with vWD undergoing major surgery. May repeat dose if needed. To minimize risk of hyponatremia and seizures, administer no more than once every 24 hours or for more than 3 consecutive days. Bookshelf Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The recommended starting dose is 1 spray (0.83 mcg) in either the left or right nostril approximately 30 minutes before going to bed. Desmopressin works by limiting the amount of water passed in the urine. September, 2004 Hospira 2004 EN-0511 Printed in USA HOSPIRA, INC., LAKE FOREST, IL 60045 USA. During treatment with DDAVP Injection, assess serum sodium, bleeding time, factor VIII coagulant activity, ristocetin cofactor activity, and von Willebrand antigen to ensure that adequate levels are being achieved. Desmopressin: Corticosteroids (Systemic) may enhance the hyponatremic . Desmopressin is contraindicated in patients with moderate to severe renal impairment (e.g., CrCl less than 50 mL/minute or eGFR less than 50 mL/minute/1.73 m2). Ketoprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. %f2fDWBRex1*s GZhlNx;hI>l!dKc:cmEg2&M*?*q$|sa[`ov#1q=[`0GP/==g5>dof?N~;1Y 1 to 2 mcg IV every 6 to 8 hours in combination with hypertonic saline. Triamcinolone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. During initial titration and continued therapy, observe and monitor closely; adjust treatment to the diurnal pattern of response. Avoid spraying in the eyes. Desmopressin increases plasma factor VIII (FVIII) and von Willebrand factor (vWF) to a greater extent than equivalent weights of vasopressin. Increased Factor VIII activity is noted 30 minutes after IV administration, with peak activity occurring in 90 minutes to 2 hours. Of course, hypertonic bicarbonate could also be used, as discussed last week. <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
Gasthuys E, Dossche L, Michelet R, Nrgaard JP, Devreese M, Croubels S, Vermeulen A, Van Bocxlaer J, Walle JV. wt. Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. Intranasal: 5 to 40 mcg/day divided into 1 to 3 doses. Careful fluid intake restrictions are required in pediatric patients to prevent hyponatremia and water intoxication. Determine need for repeat dosage based on laboratory response and patient's clinical condition. Diabetes insipidus: 2-4 mcg/day IV push or SC. Mometasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin is contraindicated in patients with known hypersensitivity to desmopressin or any ingredients in the preparation. Oxaprozin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. 2022 Mar 2;12(3):389. doi: 10.3390/biom12030389. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Desmopressin nasal spray can be resumed when these conditions resolve. Use combination with caution and monitor patients for signs and symptoms of hyponatremia, which may include seizures. Desmopressin acts similarly to native vasopressin. Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Fluid restriction should be observed, and fluid intake should be limited to a minimum from 1 hour before administration, until the next morning, or at least 8 hours after administration. Oral to IV conversion (approximate): oral dose x 0.625 = daily IV dose.. HYDROCORTISONE (SOLU CORTEF) 0 to 100mg/ 100 ml 101 to 150 mg/ 150. minlinklosubs - Hydrocortisone iv to po steroid dosing conversion. Fluid restrictions should be observed. Budesonide: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. A pharmacokinetic and pharmacodynamic comparison of desmopressin administered as whole, chewed and crushed tablets, and as an oral solution. This increase is dose-dependent, with an IV dosage of 0.4 mcg/kg producing a 300% to 400% maximum increase in Factor VIII activity. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. 2005 Oct;27(5):655-65. doi: 10.1097/01.ftd.0000168293.48226.57. Persons with conditions associated with fluid and electrolyte imbalance (i.e., cystic fibrosis, heart failure, renal disorders), habitual or psychogenic polydipsia who may drink excessive amounts of water as well as elderly or pediatric (e.g., infants, children) patients and those receiving concomitant drugs that also cause hyponatremia may be at increased risk of hyponatremia.
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