desmopressin (deamino-arginine vasopressin, dDAVP, dDVP, Noctiva, Stimate, Minirin)
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Indications
- diabetes insipidus
- bleeding associated with hemophilia A or Type I von Willebrand's disease
- 150-300 ug intranasally
- 0.3 ug/kg IV over 15-30 minutes
- 30 minutes prior to surgery
- alternative to platelet transfusion when platelet dysfunction contributes to bleeding, for example:
- enuresis[6]; nocturnal polyuria[7]
- desmopressin associated with less intracranial hemorrhage expansion in antiplatelet-associated intracranial hemorrhage but no change in clinical outcome[9]
Contraindications
- no longer approved for nocturnal enuresis, reports of serious hyponatremia[5]
- Type I von Willebrand's disease[10]
- not for use in patients with serum sodium < 135 meq/L[8]
Dosage
DDAVP nasal spray:
Nasal spray (Stimate):
- 1 spray/nostril (300 ug total)
- for individuals < 50 kg, use 150 ug total or less
- 10 & 150 ug/spray (1.5 mg/mL, 2.5 mL)
DDAVP tablets: 0.1 & 0.2 mg
Pharmacokinetics
- elimination: liver, kidney
Adverse effects
- intranasal
- conjunctivitis
- transient headache
- dizziness
- nasal congestion
- parenteral
- not common (1-10%)
- abdominal cramps, vulval pain, facial flushing, headache (transient), rhinitis, dizziness, pain at the site of injection
- uncommon (< 1%)
- thrombosis (rare)
- not common (1-10%)
- other: severe hyponatremia, seizures[4][5][8]
Laboratory
- absence of hyperresponsiveness of platelet aggregation to ristocetin indicates DDAVP administration is safe
- 24 hour urine volume to confirm nocturnal polyuria[7]
- serum sodium must be > 135 meq/L[8]
Mechanism of action
- structurally-related to arginine-vasopressin
- elicits greater antidiuretic response than does arginine-vasopressin
- causes dose-dependent increase in activities of:
- causes release of factor VIII & von Willebrand factor (vWF) from endothelial cells
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 4.0 4.1 FDA MedWatch http://www.fda.gov/medwatch/safety/2007/safety07.htm#Desmopressin
- ↑ 5.0 5.1 5.2 Prescriber's Letter 15(1): 2008 New Precautions for Use of Desmopressin Acetate (DDAVP, DDVP, Minirin, and Stimate) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240112&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 6.0 6.1 Deprecated Reference
- ↑ 7.0 7.1 7.2 7.3 FDA News Release. March 3, 2017 FDA approves first treatment for frequent urination at night due to overproduction of urine https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm544877.htm
Fralick M, Kesselheim AS. FDA Approval of Desmopressin for Nocturia. JAMA. 2017;317(20):2059-2060 Free full text Free PMC Article http://jamanetwork.com/journals/jama/article-abstract/2617966 - ↑ 8.0 8.1 8.2 8.3 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
- ↑ 9.0 9.1 Feldman EA, Meola G, Zyck S et al. Retrospective assessment of desmopressin effectiveness and safety in patients with antiplatelet-associated intracranial hemorrhage. Crit Care Med 2019 Sep 24; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31567345
- ↑ 10.0 10.1 10.2 Connell NT, James PD, Brignardello-Petersen R et al. ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease. Blood Adv 2021 Jan 12; 5:301 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33496750 PMCID: PMC7839375 Free PMC article https://ashpublications.org/bloodadvances/article/5/1/301/474884/ASH-ISTH-NHF-WFH-2021-guidelines-on-the-management
- ↑ NOCTIVA (desmopressin acetate) nasal spray, for intranasal use. Prescribing Information http://www.accessdata.fda.gov/drugsatfda_docs/label/2017/201656lbl.pdf