ADH activity : Pressor activity [DDAVP: 2000-4000: 1 Vasopressin: 1:1]. 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. Conversion from oral to intranasal: Individual dose titration is required (intranasal desmopressin ~10- to 40-fold more potent than oral desmopressin). Tricyclic antidepressants: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. A woman who took both desmopressin and ibuprofen was found in a comatose state. The pharmacokinetics of 400 microg of oral desmopressin in elderly patients with nocturia, and the correlation between the absorption of desmopressin and clinical effect. Your doctor may adjust the dose as needed. Chronic desmopressin administration may result in changes to nasal mucosa (scarring and edema), which may cause erratic and unreliable absorption. If the product has not been used for a period of 1 week, re-prime the pump by pressing once.Instruct patient on the proper technique for administering the nasal spray. Oral bioavailability: the amount of drug that enters systemic circulation when that drug is consumed orally. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Carbetapentane; 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. Desmopressin is a man-made form of vasopressin and is used to replace a low level of vasopressin. Avoid spraying in the eyes. Disclaimer. Indications: Hemophilia (increases factor VIII levels): 0.3 mcg/kg in 50ml normal saline over 15-30 minutes. NOTE: Use parenteral desmopressin in patients for whom the intranasal route is compromised or inappropriate. Copyright 2021 GlobalRPH - Web Development by, The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. 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). Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Withdraw the necessary volume of DDAVP Injection from the vial and dilute by adding to the infusion bag of 0.9% Sodium Chloride Injection, USP per Table 1. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. [61810], Initially, 10 mcg (0.1 mL) intranasally, given in 1 to 3 divided doses, then titrated to response. In the elderly, careful dosage selection and monitoring of renal function are recommended. Medically reviewed by Drugs.com. Azilsartan; Chlorthalidone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. The following pharmacist will check on these open i-Vents and close then when appropriate. So, if a patient is on a nasal (spray or intranasal) dose of 10mcg (0.1 ml) twice a day, then a suitable tablet oral dose may be 100mcg or 200mcg twice a day. Some have suggested an initial dosage range of 0.1 to 1 mcg in 1 or 2 divided doses. Ethacrynic Acid: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. Ketorolac (Toradol) Longer DOA. Vasopressin (ADH) and AnalogsVasopressin analogs, Synthetic structural analog of vasopressin (antidiuretic hormone or ADH); more potent and much longer acting than vasopressin; many dosage forms including oral, injectable, sublingual, and intranasal formsUsed for the treatment of central diabetes insipidus, primary nocturnal enuresis (PNE), spontaneous bleeding or trauma-induced hemorrhage, bleeding prophylaxis (e.g., surgical bleeding), hemophilia A or mild to moderate von Willebrand's disease, and nocturia due to nocturnal polyuria in adultsThe intranasal formulation is no longer indicated to treat PNE secondary to reports of hyponatremic-related seizures sometimes resulting in death, DDAVP, Minirin, Nocdurna, Noctiva, Stimate, DDAVP Nasal Sol: 0.1mg, 1mLDDAVP/Desmopressin/Desmopressin Acetate Intravenous Inj Sol: 1ml, 4mcgDDAVP/Desmopressin/Desmopressin Acetate Oral Tab: 0.1mg, 0.2mgDDAVP/Desmopressin/Desmopressin Acetate Subcutaneous Inj Sol: 1ml, 4mcgDDAVP/Desmopressin/Desmopressin Acetate/Minirin/Noctiva/Stimate Nasal Spray Met: 0.1mg, 0.1mL, 0.75mcg, 1mL, 1.5mg, 1.5mcgNocdurna Sublingual Tablet, SL: 27.7mcg, 55.3mcg. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Desmopressin is also used to control excessive thirst and the passage of an abnormally large amount of urine that may occur after a head injury or after certain types of surgery. I would recommend making an appointment with your regular doctor to see what might be causing this. x}n y)Zn91Iv l38Y8bIkYbX$=x:9\>?}st_~xOo^\~dt&&=\~o~g/}~y%;]V|s{h+j/~\f'iqriwZgI~IOk[b,n6'K+%Y{Y?k{]U4{H}mWRa |3}ktz_>iCy>VbZ{SZ(_!> _~{pz.5'Kxo'wW0P*okGa? It is postulated that desmopressin-induced increases in FVIII and vWF are mediated through low-affinity, extrarenal V2 receptors. A woman who took both desmopressin and ibuprofen was found in a comatose state. In general, dose selection for the geriatric patient should be cautious, usually starting at the low end of the dosing range. Infants 3 months of age and children: Ensure the patient is compliant with fluid restrictions and intake. Typical maintenance dose was 10 to 40 mcg/day (0.1 to 0.4 mL/day). 1 to 2 mcg subcutaneously twice a day or Hydralazine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. hydrochlorothiazide, nortriptyline, tranexamic acid, imipramine, desmopressin, Pamelor, Microzide, vasopressin, Tofranil. For children weighing less than 10 kg, dilute dose in 10 mL 0.9% Sodium Chloride for injection.Infuse IV slowly over 15 to 30 minutes.Pulse and blood pressure should be monitored during infusion. Persons with conditions associated with fluid and electrolyte imbalance (i.e., cystic fibrosis, heart failure, renal disorders), habitual or psychogenic polydipsia who may drink excessive amounts of water as well as elderly or pediatric (e.g., infants, children) patients and those receiving concomitant drugs that also cause hyponatremia may be at increased risk of hyponatremia. Initiate fluid restriction during treatment with DDAVP Injection [see Warnings and Precautions (5.1), Use in Specific Populations (8.4, 8.5)]. %f2fDWBRex1*s GZhlNx;hI>l!dKc:cmEg2&M*?*q$|sa[`ov#1q=[`0GP/==g5>dof?N~;1Y Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 0.3 mcg/kg/dose (Max: 20 mcg/dose) IV once. A woman who took both desmopressin and ibuprofen was found in a comatose state. Loop diuretics: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. 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. The usual dosage range is 0.1 mg to 1.2 mg PO per day, given in 2 to 3 divided doses. Children more than 12 years of age: Before SEQUENTIAL THERAPY : Refers to the act of replacing a parenteral version of a medication with its oral counterpart. In the elderly, careful fluid intake restrictions are required to prevent hyponatremia and water intoxication. DDAVP Injection (desmopressin acetate) is a man-made form of a hormone that occurs naturally in the pituitary gland used to treat hemophilia A or von Willebrand's disease Type I, and is also used to treat central cranial diabetes insipidus, and increased thirst and urination caused by head surgery or head trauma. It is chemically defined as follows: Mol. During the initial titration period and continued therapy, observe and monitor closely. Desmopressin has also been used in congenital or acquired bleeding disorders, including drug-induced platelet dysfunction (e.g., aspirin, dextran, ticlopidine, and heparin). <> Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. 2 0 obj IV: 1 to 2 mcg twice a day Chlorpheniramine; Dextromethorphan; 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. However, the amount of orally administered drug reduced for its i.p., i.m., s.c., or i.v. Tachyphylaxis (lessening of response) with repeated administration (i.e., given more frequently than every 48 hours) may occur. 50 kg or less: 150 mcg C. The pharmacist must enter Epic order comments stating "IV to PO Conversion per P&T policy for all interchanged orders. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 27.7 mcg sublingually once daily, 1 hour before bedtime without water. 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. 2002 Jun;89(9):855-62 Clin Endocrinol (Oxf). On Days 1, 3 and 5, subjects were dosed intranasally with escalating doses of AV002 nasal spray. Bumetanide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. endobj Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb. DDAVP will also stop bleeding in hemophilia A patients with episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas or mucosal bleeding. 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. If the patient was previously receiving desmopressin tablets, dose titration is required because intranasal desmopressin is approximately 10 to 40 fold more potent than oral (tablet) desmopressin. 1 to 2 mcg IV twice a day or Infants 3 months of age and children: Initially, 10 mcg (0.1 mL) intranasally into 1 nostril, may increase to 40 mcg until the patient can sleep for an adequate period of time without incidence of polyuria. Diclofenac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Adjust dose based upon response to treatment estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. For the treatment of hypothyroidism of any etiology, except during the recovery phase of subacute thyroiditis; used as a replacement in primary (thyroidal), secondary (pituitary), tertiary (hypothalamic), congenital (cretinism), or acquired hypothyroidism. If the patient was previously receiving desmopressin tablets, dose titration is required because intranasal desmopressin is approximately 10 to 40 fold more potent than oral (tablet) desmopressin. The tendency toward tachyphylaxis (lessening of response) with repeated administration given more frequently than every 48 hours should be considered in treating each patient. The initial response is reproducible if DDAVP is administered every 2 to 3 days. The effect of DDAVP was measured on F VIII/vWF complex and on plasminogen activator release. The mechanism of action of desmopressin in Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Prolonged experience with desmopressin in pregnant women over several decades, based on the available published literature and case reports, have not identified a drug associated risk of major birth defects, miscarriage or other adverse maternal or fetal outcomes. more than 50 kg: 150 mcg in each nostril. <> Ensure the serum sodium concentration is within normal limits prior to starting or resuming desmopressin therapy. 5 to 40 mcg spray intranasally twice a day or Less vasopressor activity. 2005 Oct;27(5):655-65. doi: 10.1097/01.ftd.0000168293.48226.57. 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. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 1183.34 Demeclocycline: (Major) The antidiuretic response to desmopressin or vasopressin (ADH) may be reduced in patients concomitantly receiving demeclocycline. Flunisolide: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. YES. Desmopressin is administered orally, intranasally, or parenterally (intravenous or subcutaneously). Other evaluations have indicated that the terminal half-life for desmopressin is approximately 3 hours. Bethesda, MD 20894, Web Policies Alternatively, if the patient was previously receiving intranasal therapy, the usual dose is one-tenth (1/10) of the intranasal maintenance dose. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. % Desmopressin is a synthetic analog of vasopressin used to reduce renal excretion of water in central diabetes insipidus and nocturia. 2 0 obj Desmopressin works by limiting the amount of water passed in the urine. The study had an open, randomised, four-way cross-over design. [61810], 2 to 4 mcg IV or subcutaneously given in 1 to 2 divided doses daily. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Available for Android and iOS devices. DDAVP will also stop bleeding in hemophilia A patients with episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas or mucosal bleeding. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Single-dose administration has been used for uremic bleeding in patients with renal failure; however, repeat doses are not recommended. Torsemide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. eCollection 2023. A woman who took both desmopressin and ibuprofen was found in a comatose state. 0.1 to 0.4 mL via rhinal tube intranasally twice a day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Meloxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. The pump will stay primed for up to 1 week. WBC count of 3,000mm 3. Preoperative doses may be given 2 hours prior to the scheduled procedure. In additio The initial and terminal half-lives for desmopressin are 7.8 and 75.5 minutes, respectively, resulting in a prompt onset of action with a long duration of action. Child 2-11 years The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Diphenhydramine; Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Monitor renal function and clinical status closely during use. The recommended maintenance dose is 10 mcg/day to 40 mcg/day intranasally (0.1 mL/day to 0.4 mL/day) in 1 to 3 divided doses. Intranasal: 5 to 40 mcg/day divided into 1 to 3 doses. The usual dosage range in adults is 0.5 mL (2 mcg) to 1 mL (4 mcg) daily, administered intravenously or subcutaneously, usually in two divided doses. According to the Beers Criteria, desmopressin is considered a potentially inappropriate medication (PIM) in geriatric adults and avoidance is recommended for treating nocturia or nocturnal polyuria because there is a high risk of hyponatremia and safer alternatives are available. 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.
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