Dosing and uses of DDAVP, Stimate (desmopressin)
Adult dosage forms and strengths
injectable solution
- 4mcg/mL
tablet
- 0.1mg
- 0.2mg
nasal spray
- 0.1mg/mL (5mL): Delivers 10mcg/spray
- 1.5mg/mL (2.5mL): Delivers 150mcg/spray
Diabetes Insipidus
Intranasal (DDAVP)
- 10-40 mcg/day qDay or divided q8-12hr
- Adjust morning and evening doses separately for appropriate diurnal rhythm of water turnover
PO
- Initial: 0.05 mg q12hr
- Effective range: 0.1-1.2 mg divided q8-12hr
- Observe fluid restriction
- If switching to PO from intranasal, start PO at least 12 hours after last intranasal dose
IV/SC
- 2-4 mcg/day divided q12hr or one-tenth the maintenance of intranasal dose
Hemophilia A & Von Willebrand Disease
Hemophilia with factor VIII levels greater than 5%; von Willebrand disease (type I)
0.3 mcg/kg IV over 15-30 minutes IV (for pre-op, 30 min before procedure)
Intranasal (Stimate)
- <50 kg: 150 mcg; for pre-op, give 2 hr before procedure
- >50 kg: 300 mcg; for pre-op, give 2 hr before procedure
Nocturnal Enuresis
Primary nocturnal enuresis (not intranasal)
0.2 mg PO qHS (up to 0.6 mg/day)
Uremic Bleeding in Acute or Chronic Renal Failure
0.4 mcg/kg IV over 10 minutes
Dosing Modifications
Renal impairment
- CrCl <50 mL/min: Contraindicated; has been used unlabeled in acute and chronic renal failure patients experiencing uremic bleeding or prevention of surgical bleeding
- CrCl ≥50 mL/min: No adjustments necessary
Pediatric dosage forms and strengths
injectable solution
- 4mcg/mL
tablet
- 0.1mg
- 0.2mg
nasal spray
- 0.1mg/mL (5mL): Delivers 10mcg/spray
- 1.5mg/mL (2.5mL): Delivers 150mcg/spray
Diabetes Insipidus
3 months to 12 years (intranasal)
- 5-30 mcg/day qDay or divided q12hr (using 100 mcg/mL solution)
>12 years (intranasal)
- 10-40 mcg/day qDay/divided q12hr intranasal (using 100 mcg/mL solution)
3 months to 12 years (oral)
- Initial: 0.05 mg PO q12hr
- Effective range: 0.1-1.2 mg
- If switching to PO from intranasal, start PO at least 12 hours after last intranasal dose
>12 years (oral)
- Initial: 0.05 mg PO q12hr
- Effective range: 0.1-1.2 mg divided q8-12hr
- Observe fluid restriction
- If switching to PO from intranasal, start PO at least 12 hours after last intranasal dose
IV or SC administration
3 months to 12 years (IV/SC)
- 0.1-1 mcg qDay or divided q12hr
- Initiate at low dose and increase as necessary
- Monitor serum sodium levels and urine output
>12 years (IV/SC)
- 2-4 mcg/day divided q12hr or one tenth the maintenance of intranasal dose
Nocturnal Enuresis
>6 years: 0.2 mg PO qHS (up to 0.6 mg/day)
Hemophilia A & Von Willebrand Disease
0.3 mcg/kg IV over 15-30 minutes; for preop, 30 minutes before procedure
1 spray (150 mcg) per nostril (300 mcg total dose) if >12 year of age or >50 kg body weight; administer a single spray (150 mcg) if patient > 12 years of age but < 50 kg body weight
Fluid intake should be limited 1 hr prior to dose until the next morning or at least 8 hr after administration
DDAVP, Stimate (desmopressin) adverse (side) effects
1-10%
Headache (2-5%)
GI disorder (2%)
Fatigue (10%)
Abdominal pain (2%)
Nausea (2%)
Rhinitis (3-8%)
Conjunctivitis (2%)
Edema eyes (2%)
Lacrimation disorder (2%)
Frequency not defined
Abnormal blood pressure (infrequent)
Increased heart rate
Increased blood pressure
Flushing
Seizure (rare)
Hyponatremia
Hyposmolality (rare)
Water intoxication syndrome
Thromboembolic disorder
Allergic reaction (acute)
Anaphylaxis (rare)
Warnings
Contraindications
Hypersensitivity
Hyponatremia or history of hyponatremia
Moderate to severe renal impairment (CrCl <50 mL/min)
Cautions
Hypertension
Avoid desmopressin injections in children <3 months with hemophilia A or von Willebrand disease
Coronary artery insufficiency
Fluid and electrolyte imbalance
Factor VIII levels <5% or presence of factor VIII antibodies
Avoid use in Type IIB von Willebrand disease
Use caution in patients with habitual or psychogenic polydipsia (increased risk of hypnatremia)
Risk of potentially fatal hyponatremia/seizures; may occur with any route of administration
Use alternative route of administration if changes in the nasal mucosa resulting from edema or scarring occurs
Patients should be asked to restrict fluid intake from 1 hr before to 8 hr after taking desmopressin tablets; consider alternate route (IV) if therapeutic response inadequate at maximum recommended oral dose
Interrupt therapy if patient perform activities associated with increase in water consumption or with acute illness including fever or recurrent vomiting or diarrhea
Use with caution in patients predisposed to thrombus formation; acute myocardial infarction and cerebrovascular thrombosis reported with desmopressin injection
In children and the elderly adjust fluid intake downward to decrease possibility of water intoxication and hyponatremia
Signs and symptoms associated with hyponatremia
- Headache
- Nausea/vomiting
- Decreased serum sodium
- Weight gain
- Restlessness
- Fatigue
- Lethargy
- Disorientation
- Depressed reflexes
- Loss of appetite
- Irritability
- Muscle weakness
- Muscle spasms or cramps
- Abnormal mental status (eg, hallucinations), decreased consciousness, and confusion
- Severe symptoms may include seizure, coma, and/or respiratory arrest
Pregnancy and lactation
Pregnancy category: B
Lactation: Distributed into breast milk; use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of DDAVP, Stimate (desmopressin)
Mechanism of action
Synthetic analogue of vasopressin with prompt onset and longer, more specific antidiuretic action; desmopressin increases water permeability in renal tubular cells, which in turn decreases urine volume and increases urine osmolality
Also produces dose-related increase in von Willebrand factor VIII and t-PA levels; this shortens activated partial thromboplastin time (aPTT), as well as bleeding time
Absorption
Bioavailability: 3.5% (nasal); 5% (oral; compared to intranasal, 0.16% compared to IV)
Onset: ADH effect (intranasal), 60 min; hemophilia and von Willebrand disease (IV), 30 min
Duration: 6-14 hr (intranasal, IV infusion, oral)
Peak plasma time: 1-5 hr (intranasal)
Metabolism
Unknown
Elimination
Half-life: 3.5 hr (intranasal); 3 hr (IV); 2-3 hr (PO)
Excretion: Urine
Administration
IV Administration
Dilute appropriate dose in 10 mL NS for children <10 kg or 50 mL NS for adults and children >10 kg
Infuse slowly over 15-30 min
Monitor blood pressure and pulse during infusion
