DESMOPRESSIN ACETATE

DESMOPRESSIN ACETATE (des-moe-pres'sin) DDAVP, Stimate Classifications: hormone; pituitary (antidiuretic) hormone; Therapeutic: antidiuretic hormone (adh) Prototype: Vasopressin Pregnancy Category: B

Availability

0.1 mg, 0.2 mg tablets; 0.1% nasal solution; 0.15 mg/spray nasal spray; 4 mcg/mL, 15 mcg/mL injection

Action

Synthetic analog of the natural human posterior pituitary (antidiuretic) hormone, arginine vasopressin. Has more specific and longer duration of action than antidiuretic hormone and lower incidence of allergic reactions. Reduces urine volume and osmolality of serum in patients with central diabetes insipidus by increasing reabsorption of water by kidney collecting tubules. Produces a dose-related increase in factor VIII (antihemophilic factor) and von Willebrand's factor.

Therapeutic Effect

Desmopressin is an effective replacement for antidiuretic hormone. It also can shorten or normalize bleeding time, and correct platelet adhesion abnormalities in certain patients with bleeding disorders.

Uses

To control and prevent symptoms and complications of central (neurohypophyseal) diabetes insipidus, and to relieve temporary polyuria and polydipsia associated with trauma or surgery in the pituitary region.

Unlabeled Uses

To increase factor VIII activity in selected patients with mild to moderate hemophilia A and in type I von Willebrand's disease or uremia, and to control enuresis in children.

Contraindications

Nephrogenic diabetes insipidus, type II B von Willebrand's disease; renal failure, renal impairment.

Cautious Use

Coronary artery insufficiency, hypertensive cardiovascular disease; severe CHF; older adults; history of thromboembolic disease; pregnancy (category B).

Route & Dosage

Diabetes Insipidus Adult: Intranasal 0.1–0.4 mL (10–40 mcg) in 1–3 divided doses IV/SC 2–4 mcg in 2 divided doses PO 0.2–0.4 mg/d Child: Intranasal 3 mo–12 y, 0.05–0.3 mL in 1–2 divided doses IV/SC 0.3 mcg/kg infused over 15–30 min PO 0.05 mg titrated to response Enuresis Adult/Child: Intranasal 5–40 mcg h.s. Child (≥6 y): PO 0.2 mg h.s., may titrate up to 0.6 mg h.s. Von Willebrand's Disease Adult/Child (>3 mo): IV/SC 0.3 mcg/kg 30 min preop, may repeat in 48 h if needed Renal Impairment Do not use if Clcr is <50 mL/min.

Administration

Oral

• Note that 0.2 mg PO is equivalent to 10 mcg (0.1 mL) intranasal.

Intranasal

• Follow manufacturer's instructions for proper technique with nasal spray.
• Give initial dose in the evening, and observe antidiuretic effect. Dose is increased each evening until uninterrupted sleep is obtained. If daily urine volume is more than 2 L after nocturia is controlled, morning dose is started and adjusted daily until urine volume does not exceed 1.5–2 L/24 h.

Intravenous PREPARE: Direct: Give undiluted for diabetes insipidus.   IV Infusion: Dilute 0.3 mcg/kg in 10 mL of NS (children ≤10 kg) or 50 mL of NS (children >10 kg and adults) for von Willebrand's disease (type I).   ADMINISTER: Direct: Give direct IV over 30 s for diabetes insipidus.  IV Infusion: Give over 15–30 min for von Willebrand's disease (type I).

• Store parenteral and nasal solution in refrigerator preferably at 4° C (39.2° F) unless otherwise directed. Avoid freezing.
• Nasal spray can be stored at room temperature.
• Discard solutions that are discolored or contain particulate matter.

Adverse Effects (≥1%)

All: Dose related. CNS: Transient headache, drowsiness, listlessness. Special Senses: Nasal congestion, rhinitis, nasal irritation. GI: Nausea, heartburn, mild abdominal cramps. Other: Vulval pain, shortness of breath, slight rise in BP, facial flushing, pain and swelling at injection site.

Interactions

Drug: Demeclocycline, lithium, other vasopressors may decrease antidiuretic response; carbamazepine, chlorpropamide, clofibrate may prolong antidiuretic response.

Pharmacokinetics

Absorption: 10–20% through nasal mucosa. Onset: 15–60 min. Peak: 1–5 h. Duration: 5–21 h. Distribution: Small amount crosses blood–brain barrier; distributed into breast milk. Half-Life: 76 min.

Nursing Implications

Assessment & Drug Effects

• Monitor I&O ratio and pattern (intervals). Fluid intake must be carefully controlled, particularly in older adults and the very young to avoid water retention and sodium depletion.
• Weigh patient daily and observe for edema. Severe water retention may require reduction in dosage and use of a diuretic.
• Monitor BP during dosage-regulating period and whenever drug is administered parenterally.
• Monitor urine and plasma osmolality. An increase in urine osmolality and a decrease in plasma osmolality indicate effectiveness of treatment in diabetes insipidus.

Patient & Family Education

• Report upper respiratory tract infection or nasal congestion.
• Follow manufacturer's instructions for insertion to ensure delivery of drug high into nasal cavity and not down throat. A flexible calibrated plastic tube is provided.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug