Before Blood pressure and heart rate monitoring during infusion is recommended. Tachyphylaxis (lessening of response) with repeated administration (i.e., given more frequently than every 48 hours) may occur. > = 12 years and adult: 2-4 mcg/day IV/SC divided BID or 1/10 of the . The plasma concentrations generally declined below 2 pg/mL (lower limit of quantitation) 4 to 6 hours post-dose. Diabetes insipidus: 2-4 mcg/day IV push or SC. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Peak plasma concentrations are noted within 40 to 45 minutes of a dose. Consider other treatment options for this condition. Ther Drug Monit. Codeine; Phenylephrine; Promethazine: (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. 1:2. 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. Increased FVIII and vWF levels are thought to be due to their release from endogenous reservoirs and not increased synthesis since the response is so rapid. Desmopressin is a synthetic analog of vasopressin used to reduce renal excretion of water in central diabetes insipidus and nocturia. If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. If patient responded to 20 mcg/day, the dose was adjusted downward to 10 mcg/day to see if response could be maintained. If doses other than these are required, parenteral desmopressin injection must be used.One spray (150 mcg) has an antidiuretic activity of about 600 International Units.The nasal spray must be primed prior to first use. Use this combination with caution, and monitor patients for signs and symptoms of hyponatremia. Carbinoxamine; 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. Cortisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Rotoli BM, Visigalli R, Ferrari F, Ranieri M, Tamma G, Dall'Asta V, Barilli A. Biomolecules. Carbetapentane; Diphenhydramine; 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. government site. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Sumatriptan; Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Barnabei A, Strigari L, Corsello A, Paragliola RM, Iannantuono GM, Salvatori R, Corsello SM, Torino F. Front Endocrinol (Lausanne). Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Einstein (Sao Paulo). 8600 Rockville Pike doi: 10.1136/tsaco-2021-000852. Children younger than 12 years of ageUse and dose must be determined by your doctor. Repeat dosing is not recommended due to tachyphylaxis. Preoperative IV doses may be given 30 minutes prior to scheduled procedure. administration route. Dopamine: (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 dopamine only with careful patient monitoring. Desmopressin (dDAVP), a synthetic analogue of 8-arginine vasopressin (ADH), is an antidiuretic . Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. 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. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Immune Checkpoint Inhibitors as a Threat to the Hypothalamus-Pituitary Axis: A Completed Puzzle. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. This medication helps to control increased thirst and too much urination due to these conditions . Hvistendahl GM, Riis A, Nrgaard JP, Djurhuus JC. Etodolac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Blood pressure and pulse should be monitored during infusion. Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. <>/Metadata 485 0 R/ViewerPreferences 486 0 R>> Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Persons with vWD subtype 1C, which is characterized by a shorted vWF half-life, may require alternative management in the setting of surgery. The resultant increases in FVIII and vWF are similar to those seen with replacement therapy using blood products. 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. Treatment has been given safely to pediatric patients for up to 6 months. 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. 4. MeSH The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Indomethacin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Store refrigerated 2 to 8C (36 to 46F). Dose range is 0.1 to 1.2 mg divided into 2 or 3 doses. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 2 0 obj Desmopressin (DDAVP) in the Treatment of Bleeding Disorders: The First SEQUENTIAL THERAPY : Refers to the act of replacing a parenteral version of a medication with its oral counterpart. Desmopressin. Initial dose: 0.05 mg orally twice a day or After at least 7 days of treatment, the dose may be increased to 1.66 mcg, if needed, provided the serum sodium is within the normal range during treatment with the 0.83 mcg dose. The 0.83 mcg dose did not meet all prespecified efficacy endpoints in clinical trials, but may have a lower risk of hyponatremia. Oxaprozin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Pediatric Pharmacology of Desmopressin in Children with Enuresis: A Comprehensive Review. Maintenance dose range: 10 mcg/day to 30 mcg/day intranasally (0.1 mL/day to 0.3 mL/day) in 1 to 2 divided doses. C. The pharmacist must enter Epic order comments stating "IV to PO Conversion per P&T policy for all interchanged orders. Dose range is 5 to 30 mcg/day. 1183.34 DDAVP (2 micrograms IV q8hr) is started immediately and continued until the sodium is close to normal. Monitor renal function and clinical status closely during use. An official website of the United States government. The pump will stay primed for up to 1 week. ADH activity : Pressor activity [DDAVP: 2000-4000: 1 Vasopressin: 1:1]. Medically reviewed by Drugs.com. Budesonide; Formoterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Bendroflumethiazide; Nadolol: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Ciclesonide: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Hemophilia A and von Willebrand's Disease (Type I): The recommended dosage is 0.3 mcg/kg actual body weight (to a maximum of 20 mcg) administered by intravenous infusion over 15 minutes to 30 minutes. It is postulated that desmopressin-induced increases in FVIII and vWF are mediated through low-affinity, extrarenal V2 receptors. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. {+/7VPerb}6Wz+>8. %f2fDWBRex1*s GZhlNx;hI>l!dKc:cmEg2&M*?*q$|sa[`ov#1q=[`0GP/==g5>dof?N~;1Y Twist off the seal from the dropper. Adult dosing should not be used in this age group; adverse events such as hyponatremia-induced seizures may occur. Infants 3 months of age to children 12 years of age: Example: Ampicillin-sulbactam 1.5gm IV Q6H to amoxicillin-clavulanic acid 875mg/125mg PO Q12H. PDF IV to PO Conversion of Medications: Associated cost savings and reduced Brand Names. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Individualize dosing to prevent an excessive decrease in plasma osmolality, which can lead to hyponatremia and possible seizures. However, individualized dosing is recommended due to high inter-patient variability in response. 1 After the original clinical study performed in Italy, desmopressin was used in Dose should be reduced. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Vincristine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including vincristine. The antidiuretic effects of the drug last for about 5 to 21 hours, followed by an abrupt cessation of activity that occurs over a 60- to 90-minute period. 4 0 obj This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The necessity for repeat administration of DDAVP or use of any blood products for hemostasis should be determined by laboratory response as well as the clinical condition of the patient. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Wash the rhinal tube in water and shake well, until no water is left in the tube.To avoid the spread of infection, do not use the container for more than 1 person.For 2.5 mL bottles, discard after 25 sprays (doses) because the amount delivered thereafter per spray may be substantially less than the recommended dose. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Also assess serum sodium and aPTT prior to treatment. Fatal anaphylaxis has been reported with intravenous desmopressin. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. During treatment with DDAVP Injection, assess serum sodium, bleeding time, factor VIII coagulant activity, ristocetin cofactor activity, and von Willebrand antigen to ensure that adequate levels are being achieved. Put the other end of the tube into the patients mouth; the patient should hold their breath.Tilt the patient's head back and have them blow with a short strong puff through the tube. Following oral administration, the bioavailability of desmopressin is about 5% and 0.16% compared to intranasal and intravenous administration, respectively. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 1997;183:53-4. DDAVP, Stimate (desmopressin) dosing, indications, interactions Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. 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. If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. Desmopressin is not indicated for persons with severe classic vWD (type 1), for the treatment of hemophilia B, or in persons with factor VIII antibodies. The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced. 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. 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. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Pretreatment Testing and On-Treatment Monitoring Diabetes Insipidus Prior to treatment with DDAVP, assess serum sodium, urine volume and osmolality. If the patient was previously receiving desmopressin injection, administer 10 times the amount of desmopressin acetate, rounding down to the nearest 10 mcg. If administered more than once a day, adjust for an adequate diurnal rhythm of urine output. A woman who took both desmopressin and ibuprofen was found in a comatose state. Med Surg ATI Proctored Exam Test Bank A 1 Preoperative doses may be given 2 hours prior to the scheduled procedure. Available for Android and iOS devices. Bupivacaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Clipboard, Search History, and several other advanced features are temporarily unavailable. . 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. Desmopressin: Dosage, Mechanism/Onset of Action, Half-Life - Medicine.com 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.