Desmopressin (injection): Difference between revisions

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**Injection: 0.5mL - 1.0mL at 4 mcg/mL IV or SC, usually divided in two doses   
**Injection: 0.5mL - 1.0mL at 4 mcg/mL IV or SC, usually divided in two doses   
**Tablets: 0.05 mcg PO q12h. Total daily dosage should be increased or decreased in the range of 0.1 mg to 1.2 mg divided into two or three daily doses as needed to obtain adequate antidiuresis.  
**Tablets: 0.05 mcg PO q12h. Total daily dosage should be increased or decreased in the range of 0.1 mg to 1.2 mg divided into two or three daily doses as needed to obtain adequate antidiuresis.  
**Rhinal Spray: 0.1 to 0.4 mL daily, either as a single dose or divided into two or three doses.  
**Nasal Spray: 0.1 to 0.4 mL daily, either as a single dose or divided into two or three doses.  
====Hemophilia A with factor VIII Coagulant Activity > 5%====
====Hemophilia A with factor VIII Coagulant Activity > 5%====
*Dosage  
*Dosage  
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Evidence: profilaxis during labour against bleeding. <ref name="pmid1861812">{{cite journal| author=Rochelson B, Caruso R, Davenport D, Kaelber A| title=The use of prophylactic desmopressin (DDAVP) in labor to prevent hemorrhage in a patient with Ehlers-Danlos syndrome. | journal=N Y State J Med | year= 1991 | volume= 91 | issue= 6 | pages= 268-9 | pmid=1861812 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1861812  }} </ref>
Evidence: profilaxis during labour against bleeding. <ref name="pmid1861812">{{cite journal| author=Rochelson B, Caruso R, Davenport D, Kaelber A| title=The use of prophylactic desmopressin (DDAVP) in labor to prevent hemorrhage in a patient with Ehlers-Danlos syndrome. | journal=N Y State J Med | year= 1991 | volume= 91 | issue= 6 | pages= 268-9 | pmid=1861812 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1861812  }} </ref>


====Hemorrhage-Uremia=====
====Hemorrhage-Uremia====
*Dosage: 0.4 microgram/kg IV infusion in patients with chronic renal failure, shortened bleeding time. <ref name="pmid6728864">{{cite journal| author=Watson AJ, Keogh JA| title=1-Deamino-8-d-arginine vasopressin (DDAVP): a potential new treatment for the bleeding diathesis of acute renal failure. | journal=Pharmatherapeutica | year= 1984 | volume= 3 | issue= 9 | pages= 618-22 | pmid=6728864 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6728864  }} </ref>
*Dosage: 0.4 microgram/kg IV infusion in patients with chronic renal failure, shortened bleeding time. <ref name="pmid6728864">{{cite journal| author=Watson AJ, Keogh JA| title=1-Deamino-8-d-arginine vasopressin (DDAVP): a potential new treatment for the bleeding diathesis of acute renal failure. | journal=Pharmatherapeutica | year= 1984 | volume= 3 | issue= 9 | pages= 618-22 | pmid=6728864 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6728864  }} </ref>


Line 33: Line 33:
*Dosage: 100 mcg (men) and 25 mcg (women) reduces nocturnal voids in 33%. <ref name="pmid22447415">{{cite journal| author=Weiss JP, Zinner NR, Klein BM, Nørgaard JP| title=Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial. | journal=Neurourol Urodyn | year= 2012 | volume= 31 | issue= 4 | pages= 441-7 | pmid=22447415 | doi=10.1002/nau.22243 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22447415  }} </ref>
*Dosage: 100 mcg (men) and 25 mcg (women) reduces nocturnal voids in 33%. <ref name="pmid22447415">{{cite journal| author=Weiss JP, Zinner NR, Klein BM, Nørgaard JP| title=Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial. | journal=Neurourol Urodyn | year= 2012 | volume= 31 | issue= 4 | pages= 441-7 | pmid=22447415 | doi=10.1002/nau.22243 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22447415  }} </ref>


 
====Urine Concentration Test====
*Dosage: 10 mcg intranasally after 12 hours of water depravation concentrated urine in patients as if they were on 24-36 hours of water depravation<ref name="pmid7418281">{{cite journal| author=Nadvorníková H, Schück O, Cort JH| title=A standardized desmopressin test of renal concentrating ability. | journal=Clin Nephrol | year= 1980 | volume= 14 | issue= 3 | pages= 142-7 | pmid=7418281 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7418281  }} </ref>.
|fdaLIADPed=====Primary Nocturnal Enuresis====
|fdaLIADPed=====Primary Nocturnal Enuresis====
*Dosage:  
*Dosage:  
Line 40: Line 41:
====Central Cranial Diabetes Insipidus====
====Central Cranial Diabetes Insipidus====
*Dosage:  
*Dosage:  
**Rhinal Spray: (Patients 3 months - 12 years old), 0.05 to 0.3 mL daily, either as a single dose or divided into two doses.  
**Nasal Spray: (Patients 3 months - 12 years old), 0.05 to 0.3 mL daily, either as a single dose or divided into two doses.  


====Hemophilia A with factor VIII Coagulant Activity > 5%====
====Hemophilia A with factor VIII Coagulant Activity > 5%====
Line 52: Line 53:
|offLabelPedNoGuideSupport=====Urinary Incontinence====
|offLabelPedNoGuideSupport=====Urinary Incontinence====
*Dosage: Desmopressin administered at bedtime at increasing dosages from 10 to 30 mcg with intranasal spray until effective. <ref name="pmid10468731">{{cite journal| author=Caione P, Nappo S, De Castro R, Prestipino M, Capozza N| title=Low-dose desmopressin in the treatment of nocturnal urinary incontinence in the exstrophy-epispadias complex. | journal=BJU Int | year= 1999 | volume= 84 | issue= 3 | pages= 329-34 | pmid=10468731 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10468731  }} </ref>
*Dosage: Desmopressin administered at bedtime at increasing dosages from 10 to 30 mcg with intranasal spray until effective. <ref name="pmid10468731">{{cite journal| author=Caione P, Nappo S, De Castro R, Prestipino M, Capozza N| title=Low-dose desmopressin in the treatment of nocturnal urinary incontinence in the exstrophy-epispadias complex. | journal=BJU Int | year= 1999 | volume= 84 | issue= 3 | pages= 329-34 | pmid=10468731 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10468731  }} </ref>
====Urine Concentration Test====
*Dosage: 50 mcg intranasally in children, optimal urine concentration was achieved by 3-5 hours <ref name="pmid7057511">{{cite journal| author=Helin I| title=Intranasal DDAVP test in children. | journal=J Urol | year= 1982 | volume= 127 | issue= 1 | pages= 78-9 | pmid=7057511 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7057511  }} </ref>.
|contraindications=Contraindicated in:  
|contraindications=Contraindicated in:  
  *Individuals with known hypersensitivity to desmopressin acetate or to any of the components of DDAVP tablets.
  *Individuals with known hypersensitivity to desmopressin acetate or to any of the components of DDAVP tablets.

Revision as of 14:16, 18 December 2014

Desmopressin (injection)
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alberto Plate [2]

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Overview

Desmopressin (injection) is a hemostatic and endocrine-metabolic agent that is FDA approved for the treatment of central diabetes insipidus and primary nocturnal enuresis. Common adverse reactions include fatigue and rhinitis.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Central Cranial Diabetes Insipidus

  • Dosage:
    • Injection: 0.5mL - 1.0mL at 4 mcg/mL IV or SC, usually divided in two doses
    • Tablets: 0.05 mcg PO q12h. Total daily dosage should be increased or decreased in the range of 0.1 mg to 1.2 mg divided into two or three daily doses as needed to obtain adequate antidiuresis.
    • Nasal Spray: 0.1 to 0.4 mL daily, either as a single dose or divided into two or three doses.

Hemophilia A with factor VIII Coagulant Activity > 5%

  • Dosage
    • Injection: 4 mcg/mL IV at 0.3 mcg/kg of body weight infused in 15-30 minutes. In adults and children weighing more than 10 kg, 50 mL of diluent is recommended; in children weighing 10 kg or less, 10 mL of diluent is recommended.

Von Willebrand's Disease

  • Dosage:
    • Injection: 4 mcg/mL IV at 0.3 mcg/kg of body weight infused in 15-30 minutes. In adults and children weighing more than 10 kg, 50 mL of diluent is recommended; in children weighing 10 kg or less, 10 mL of diluent is recommended.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Desmopressin (patient information) in adult patients.

Non–Guideline-Supported Use

Diagnosis of Cushing's Syndrome

  • Dosage: 5-10 mcg IV has proven ability to stimulate the pituitary-adrenal axis in a set of patients with Cushing's Syndrome, being useful in the differential diagnosis of the given pathology. [1]

Ehlers-Danlos Syndrome

Evidence: profilaxis during labour against bleeding. [2]

Hemorrhage-Uremia

  • Dosage: 0.4 microgram/kg IV infusion in patients with chronic renal failure, shortened bleeding time. [3]

Nocturia

  • Dosage: 100 mcg (men) and 25 mcg (women) reduces nocturnal voids in 33%. [4]

Urine Concentration Test

  • Dosage: 10 mcg intranasally after 12 hours of water depravation concentrated urine in patients as if they were on 24-36 hours of water depravation[5].

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Primary Nocturnal Enuresis

  • Dosage:
    • Tablets: (Patients >6 years): Initial dose of 0.2 mg at bedtime. The dose may be titrated up to 0.6 mg to achieve the desired response.

Central Cranial Diabetes Insipidus

  • Dosage:
    • Nasal Spray: (Patients 3 months - 12 years old), 0.05 to 0.3 mL daily, either as a single dose or divided into two doses.

Hemophilia A with factor VIII Coagulant Activity > 5%

  • Dosage:
    • Injection: 4 mcg/mL IV at 0.3 mcg/kg of body weight infused in 15-30 minutes. In adults and children weighing more than 10 kg, 50 mL of diluent is recommended; in children weighing 10 kg or less, 10 mL of diluent is recommended.

Von Willebrand's Disease

  • Dosage:
    • Injection: 4 mcg/mL IV at 0.3 mcg/kg of body weight infused in 15-30 minutes. In adults and children weighing more than 10 kg, 50 mL of diluent is recommended; in children weighing 10 kg or less, 10 mL of diluent is recommended.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Desmopressin (patient information) in pediatric patients.

Non–Guideline-Supported Use

Urinary Incontinence

  • Dosage: Desmopressin administered at bedtime at increasing dosages from 10 to 30 mcg with intranasal spray until effective. [6]

Urine Concentration Test

  • Dosage: 50 mcg intranasally in children, optimal urine concentration was achieved by 3-5 hours [7].

Contraindications

Contraindicated in: 

*Individuals with known hypersensitivity to desmopressin acetate or to any of the components of DDAVP tablets.
  • Patients with moderate to severe renal impairment (defined as a creatinine clearance below 50ml/min).
  • Patients with hyponatremia or a history of hyponatremia.

Warnings

There is limited information regarding Desmopressin (injection) Warnings' in the drug label.

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Desmopressin (injection) Clinical Trials Experience in the drug label.

Postmarketing Experience

There is limited information regarding Desmopressin (injection) Postmarketing Experience in the drug label.

Drug Interactions

There is limited information regarding Desmopressin (injection) Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): There is no FDA guidance on usage of Desmopressin (injection) in women who are pregnant.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Desmopressin (injection) in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Desmopressin (injection) during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Desmopressin (injection) in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Desmopressin (injection) in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Desmopressin (injection) in geriatric settings.

Gender

There is no FDA guidance on the use of Desmopressin (injection) with respect to specific gender populations.

Race

There is no FDA guidance on the use of Desmopressin (injection) with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Desmopressin (injection) in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Desmopressin (injection) in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Desmopressin (injection) in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Desmopressin (injection) in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Desmopressin (injection) Administration in the drug label.

Monitoring

There is limited information regarding Desmopressin (injection) Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Desmopressin (injection) and IV administrations.

Overdosage

There is limited information regarding Desmopressin (injection) overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

There is limited information regarding Desmopressin (injection) Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Desmopressin (injection) Mechanism of Action in the drug label.

Structure

There is limited information regarding Desmopressin (injection) Structure in the drug label.

Pharmacodynamics

There is limited information regarding Desmopressin (injection) Pharmacodynamics in the drug label.

Pharmacokinetics

There is limited information regarding Desmopressin (injection) Pharmacokinetics in the drug label.

Nonclinical Toxicology

There is limited information regarding Desmopressin (injection) Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Desmopressin (injection) Clinical Studies in the drug label.

How Supplied

There is limited information regarding Desmopressin (injection) How Supplied in the drug label.

Storage

There is limited information regarding Desmopressin (injection) Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Desmopressin (injection) |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Desmopressin (injection) |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Desmopressin (injection) Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Desmopressin (patient information) interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Desmopressin (injection) Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Desmopressin (injection) Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ Malerbi DA, Mendonça BB, Liberman B, Toledo SP, Corradini MC, Cunha-Neto MB; et al. (1993). "The desmopressin stimulation test in the differential diagnosis of Cushing's syndrome". Clin Endocrinol (Oxf). 38 (5): 463–72. PMID 8330442.
  2. ↑ Rochelson B, Caruso R, Davenport D, Kaelber A (1991). "The use of prophylactic desmopressin (DDAVP) in labor to prevent hemorrhage in a patient with Ehlers-Danlos syndrome". N Y State J Med. 91 (6): 268–9. PMID 1861812.
  3. ↑ Watson AJ, Keogh JA (1984). "1-Deamino-8-d-arginine vasopressin (DDAVP): a potential new treatment for the bleeding diathesis of acute renal failure". Pharmatherapeutica. 3 (9): 618–22. PMID 6728864.
  4. ↑ Weiss JP, Zinner NR, Klein BM, Nørgaard JP (2012). "Desmopressin orally disintegrating tablet effectively reduces nocturia: results of a randomized, double-blind, placebo-controlled trial". Neurourol Urodyn. 31 (4): 441–7. doi:10.1002/nau.22243. PMID 22447415.
  5. ↑ Nadvorníková H, Schück O, Cort JH (1980). "A standardized desmopressin test of renal concentrating ability". Clin Nephrol. 14 (3): 142–7. PMID 7418281.
  6. ↑ Caione P, Nappo S, De Castro R, Prestipino M, Capozza N (1999). "Low-dose desmopressin in the treatment of nocturnal urinary incontinence in the exstrophy-epispadias complex". BJU Int. 84 (3): 329–34. PMID 10468731.
  7. ↑ Helin I (1982). "Intranasal DDAVP test in children". J Urol. 127 (1): 78–9. PMID 7057511.
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