Desmopressin
Classification
Synthetic analog of vasopressin
Indications
CCP: Diabetes insipidus
CCP: Hemophilia A with factor VIII coagulant activity levels greater than 5%.
CCP: Von Willebrand disease (Type 1)
Contraindications
- Hypersensitivity
- Patients < 3 months
- CrCl < 50ml/min
- Von Willebrand disease Type IIB
- Hyponatremia
Caution
- Renal impairment
- Fluid and electrolyte imbalance
- Polydipsia, habitual or psychogenic
- Elderly patients
- Cystic fibrosis
- CAD
- HTN
- CHF
- Thrombosis risk
Adult dosages
CCP: Diabetes Insipidus
- 1-2 mcg IV
CCP: Hemophilia A
- 0.3 mcg/kg/dose IV x 1
CCP: Von Willebrand Type 1
- 0.3 mcg/kg/dose IV x 1
Pediatric Considerations And Dosing
CCP: Diabetes insipidus
- < 4 years of age
- 0.1-0.8 mg/day PO (start 0.05 mg PO qd)
- 4-12 years of age
- 0.1-1.2 mg/day PO (start 0.05 mg PO bid)
- >12 years of age
- 0.1-1.2 mg/day PO (start 0.05 mg PO bid)
- Or 1-2 mcg IV bid to a max of 4 mcg/day
CCP: Hemophilia A
- 3 months and older
- 0.3 mcg/kg/dose IV x 1
CCP: Von Willebrand Type 1
- 3 months and older
- 0.3 mcg/kg/dose IV x 1
Mechanism Of Action
Synthetic analog of vasopressin with a prompt onset and a longer duration than vasopressin. DDAVP also has a more specific antidiuretic action than vasopressin. DDAVP increases water permeability in renal tubular cells, that in turn decreases urine volume and increases urine osmolality. The antidiuretic effects are mediated by the stimulation of vasopressin 2 receptors, thereby increasing water re-absorption, and reducing urine production. DDAVP also produces a dose-related increase in von Willebrand factor VIII and t-PA levels, that shortens aPTT and bleeding time.
Pharmacokinetics
Onset: 30 minutes IV
Duration: 6-14 hours
Peak plasma time: 1-5 hours
Half-life: 3 hours IV
Adverse Effects
- Anaphylaxis
- Headache
- Hyponatremia
- Dizziness
- Epistaxis
- Thrombosis
- Seizures
- Water intoxication
- HTN
- Hypotension
Warning And Precautions
- Use with caution inpatients with habitual or psychogenic polydipsia.
- Rapid IV infusions may result in severe hypotension.
- Use with caution in patients with a predisposition to thrombus formation.
- Therapy may worsen underlying conditions due to fluid retention.
- Adjust the fluid intake in the elderly and children to decrease the possibility of water intoxication.
Drug Interactions
- Mometasone
- Benzphetamine
- Carbamazepine
- Chlorpropamide
- Dexfenfluramine
- Dexmethylphenidate
- Dextroamphetamine
- Diethylpropion
- Dobutamine
- Dopamine
- Ephedrine
- Epinephrine
- Fenfluramine
- Isoproterenol
- Lisdexamfetamine
- Methamphetamine
- Methylenedioxymethamphetamine
- Methylphenidate
- Midodrine
- Norepinephrine
- Phendimetrazine
- Phentermine
- Phenylephrine
- Pseudoephedrine
- Xylometazoline
- yohimbine