Desmopressin: Indication, Dosage, Side Effect, Precaution

Generic Medicine Info Patient Medicine Information

This information is not country-specific. Please refer to the Myanmar prescribing information.

Generic Medicine Info

Indications and Dosage

Intramuscular, Subcutaneous
Diagnosis of diabetes insipidus

Adult: 2 mcg via IM or SC inj.
Child: Same as adult dose.

Intramuscular, Intravenous, Subcutaneous
Cranial diabetes insipidus

Adult: 1-4 mcg once daily via IV, IM or SC inj.
Child: 0.4 mcg daily via IV, IM, SC inj.

Intramuscular, Subcutaneous
Renal function testing

Adult: 2 mcg via IM or SC inj.
Child: Same as adult dose.

Intramuscular, Subcutaneous
Headache following lumbar puncture

Adult: 4 mcg via IM or SC inj, may be repeated after 24 hr if needed. May also be given as prophylaxis.

Intravenous
Testing of fibrinolytic response

Adult: 0.4 mcg/kg infusion over 20 min.
Child: Same as adult dose.

Intravenous
Type I Von Willebrand's disease

Adult: 0.4 mcg/kg by slow infusion over 15-30 min before surgery. Further dose may be given at 12-hr interval.
Child: Same as adult dose.

Nasal
Type I Von Willebrand's disease

Adult: 300 mcg; <50 kg: 150 mcg. Should be given 0.5-2 hr before surgery.

Nasal
Diagnosis of diabetes insipidus

Adult: 20 mcg as a single dose.
Child: Same as adult dose.

Nasal
Renal function testing

Adult: 40 mcg as a single dose.
Child: ≤1 yr 10 mcg; >1-15 yr 20 mcg. Both given as a single dose.

Nasal
Nocturia associated with multiple sclerosis

Adult: 10-20 mcg at bedtime.

Nasal
Cranial diabetes insipidus

Adult: 10-20 mcg once daily or bid.
Child: 5-20 mcg daily. Infants may require lower dose.

Oral
Cranial diabetes insipidus

Adult: Initially, 100 mcg tid, adjust according to response. Maintenance: 100-200 mcg tid up to 100-1,200 mcg daily.
Child: Same as adult dose.

Oral
Primary nocturnal enuresis

Adult: Initially, 200 mcg at bedtime, may titrate up to 600 mcg to achieve desired response.
Child: ≥6 yr Initially, 200 mcg at bedtime, may titrate up to 600 mcg to achieve desired response.

Sublingual
Cranial diabetes insipidus

Adult: Initially, 60 mcg tid. Maintenance: 60-120 mcg tid up to 720 mcg daily.
Child: Same as adult dose.

Administration

May be taken with or without food.

Reconstitution

IV infusion: Dilute in 10 mL or 50 mL of NaCl 0.9% inj.

Contraindications

Cardiac insufficiency w/ ongoing diuretic treatment. Patient w/ habitual and psychogenic polydipsia, hyponatraemia or history of hyponatraemia. Moderate to severe renal impairment (CrCl <50 mL/min).

Special Precautions

Patient w/ CV disease or cystic fibrosis, coronary artery insufficiency, at risk for increased intracranial pressure, predisposed to thrombus formation. Elderly and childn. Pregnancy and lactation.

Adverse Reactions

Headache, nausea, stomach pain, allergic skin reaction and more severe general allergic reactions, cerebral or coronary thrombosis. Local irritation, congestion and epistaxis. Pain and swelling at the inj site.
Potentially Fatal: Anaphylaxis.

Pregnancy Category (US FDA)

IM/IV/Nasal/Parenteral/PO/SC: B

Monitoring Parameters

Monitor BP and pulse during IV infusion.

Overdosage

Symptoms: Prolonged duration of action w/ an increased risk of water retention and/or hyponatraemia. Management: Symptomatic treatment. Fluid restriction.

Drug Interactions

May enhance antidiuretic effect w/ NSAIDs (e.g. ibuprofen), indometacin, TCAs, chlorpromazine, carbamazepine, SSRIs, opiates, lamotrigine. May reduce antidiuretic effect w/ lithium, epinephrine (large dose), heparin, demeclocycline.

Food Interaction

May reduce antidiuretic effect w/ alcohol.

Action

Description: Desmopressin increases cyclic adenosine monophosphate (cAMP) in renal tubular cells which increases water permeability resulting in reduced urine volume and enhanced urine osmolality. It also stimulates factor VII and plasminogen activator activity in the blood, but w/ minimal pressor activity.
Onset: Antidiuretic: Approx 60 min (oral); 15-30 min (intranasal).
Duration: Approx 6-14 hr.
Pharmacokinetics:
Absorption: Absorbed minimally from the GI tract; absorbed from the nasal mucosa. Bioavailability: 0.08-0.16% (oral); 10-20% (intranasal). Time to peak plasma concentration: 0.9 hr (oral); 1.5 hr (intranasal).
Excretion: Mainly via urine. Elimination half-life: 2-4 hr.

Chemical Structure

Storage

Store between 20-25°C. Soln for inj: Store between 2-8°C. Protect from light.

MIMS Class

Antidiuretics

ATC Classification

H01BA02 - desmopressin ; Belongs to the class of vasopressin and analogues. Used in posterior pituitary lobe hormone preparations.

References

Anon. Desmopressin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 18/01/2016.

Buckingham R (ed). Desmopressin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 18/01/2016.

DDAVP Solution (Sanofi-aventis U.S. LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 18/01/2016.

DDAVP Tablet (Sanofi-aventis U.S. LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 18/01/2016.

Desmopressin Acetate Injection, Solution (Sun Pharmaceutical Industries Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 18/01/2016.

Information for Healthcare Professionals: Desmopressin Acetate (marketed as DDAVP Nasal Spray, DDAVP Rhinal Tube, DDAVP, DDVP, Minirin, and Stimate Nasal Spray). U.S. FDA. https://www.fda.gov/. Accessed 18/01/2016.

Joint Formulary Committee. Desmopressin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 18/01/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Desmopressin Acetate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 18/01/2016.

Stimate (desmopressin acetate) 1.5 mg/mL Nasal Spray. U.S. FDA. https://www.fda.gov/. Accessed 18/01/2016.

Stimate Spray, Metered (CSL Behring LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 18/01/2016.

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