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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