Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Medically reviewed by Drugs.com. IV: 0.3 mcg/kg once slowly over 15-30 minutes. Doses may be titrated up to 0.6 mg PO once daily at bedtime, depending on individual patient response. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours. Response should be estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. [61810], Initially, 5 mcg (0.05 mL) intranasally, given in 1 to 2 divided doses, then titrated to response. This is probably due to saturation of receptor sites. Do not use desmopressin as sole therapy in persons with vWD undergoing major surgery. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Do not transfer any remaining solution to another bottle. Clipboard, Search History, and several other advanced features are temporarily unavailable. IV: 0.3 mcg/kg by slow infusion over 15-30 minutes beginning 30 minutes before procedure. Azelastine; Fluticasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. xTMk1?DFh!PiHhmz(=lk;p"v< Fobt7t?@IFT];XaYV={~w ^JLAIIG\G\m$XJe@xH8!ZDhrN*'VH4'J.cq 'A%;v}q+i+&L 44qDxR)o3 The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. 1997;183:53-4. 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. Infusion Pump Required. Desmopressin in nocturnal enuresis 677,ug given intranasally wasequivalent to 400[ig given orally.8 Wedecidedto comparethe 20 igintranasal dose with the 200 tg oral dose, whichwefoundin a pilot study to be as effective as a 400 ptg dose, but with less effect on serum electrolytes and body weight. Geriatric patients 65 years of age and older treated with desmopressin for nocturia had a higher incidence of hyponatremia compared to patients less than 65 years old; therefore, monitor serum sodium more frequently in these patients. 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. 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. Commonly central DI is treated with desmopressin. Tolvaptan is a V2 receptor antagonist and may interfere with the V2 agonist activity of DDAVP. Desmopressin intranasal formulations are no longer indicated for the treatment of primary nocturnal enuresis due to the risk for developing severe hyponatremia that can result in seizures and death. Methods: The study had an open, randomised, four-way cross-over design. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Reassess patient after the initial 24 hours; if clinical status has improved may begin gradually tapering the dose. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. His endocranologist only wants him to use it one time a day, but the problem is he goes to the bathroom sometimes every 15 minutes!!! Formoterol; Mometasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Once the dose is in the tube, hold the tube with your fingers, about 3/4 inch from the end.Put the tube into a nostril, until your fingers touch the nostril. If used preoperatively, administer 2 hours before surgery. 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. Child 2-11 years Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Fatal anaphylaxis has been reported with intravenous desmopressin. A woman who took both desmopressin and ibuprofen was found in a comatose state. 1. Typical maintenance dose was 10 to 40 mcg/day (0.1 to 0.4 mL/day). Conversion from oral to intranasal: Individual dose titration is required (intranasal desmopressin ~10- to 40-fold more potent than oral desmopressin). Guidelines recommend administering no more than once every 24 hours or for more than 3 consecutive days to minimize risk of hyponatremia and seizures. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Lamotrigine: (Major) Caution is recommended if a drug that may increase the risk of water intoxication with hyponatremia, such as lamotrigine, is administered with desmopressin acetate. [33605], Initially, 10 mcg (0.1 mL) intranasally into 1 nostril, may increase to 30 mcg until the patient can sleep for an adequate period of time without incidence of polyuria. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. endobj Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Cyclizine SC or IV Nausea and vomiting 0.5 1 14.5 0 Diamorphine$ SC or IV Pain 0.075 0.1 2.175 2.9 1.45 3.2625 Diazepam PR Agitation, convulsions 10 Hydrocortisone IV Anaphylaxis 2 4 58 116 Hyoscine hydrobromide SC or IV Respiratory tract secretions 0.01 0.01 0.29 0.29 Midazolam SC or IV Anxiety or agitation 0.06 0.1 1.74 2.9 2 4.5 Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. For a patient requiring volume resuscitation, a large volume of normal saline could be . Max IV rate (usual): 5 mg/min. The bioavailability was 0.08%. IV injection due to hypotension, bradycardia, and arrhythmias. Bioavailability was estimated using AUC(0-->t) for the oral and the intravenous periods. Dexamethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Repeat administration should be determined by laboratory response as well as the clinical condition of the patient. Careful fluid intake restrictions are required to prevent hyponatremia and water intoxication. 3 0 obj Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Desmopressin has been used safely in many women during pregnancy, including those with bleeding disorders and diabetes insipidus. 0.3 mcg/kg/dose (Max: 20 mcg/dose) IV once. -, BJU Int. 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? 2020 Aug;22(4):369-383. doi: 10.1007/s40272-020-00401-7. LV>T6If7>LYJTgJ^kyf>[7Sz]>mCh^3r3a2Lmm$9_5y/;D|s }3a7+NGv46p?MISiZ?dV?pmSosEIN.6DLY}%OL!+Cuf^C;\EvwgOv|2> V,>1w|>>O[[ej,UdSg,ufiEI'&c3Y_$x_'Ifm9s;KY|{AuLTiv[V>n~>r`-@Z(^++Gj~Stsz|6jmm/1dEIz$+ZE7c0rw@GRt=%K2*#g`9'Jp?Hol+c/1K6//1-=d#~t*8t)~H0E>ue)'U'$L Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced. 1995 Apr;42(4):373-8. doi: 10.1111/j.1365-2265.1995.tb02645.x [ PubMed ] 10646654 Yamamoto T, Fukuyama J, Fujiyoshi A. During initial titration and continued therapy, observe and monitor closely; adjust treatment to the diurnal pattern of response. Initially, 0.05 mg PO twice daily. Caution should be used when coadministering these agents. [61810], Initially, 10 mcg (0.1 mL) intranasally, given in 1 to 3 divided doses, then titrated to response. Guardrail Drug Requires documentation of two (2) RN's for double-checking. Use desmopressin nasal spray for nocturia with caution and monitoring of blood volume status in persons with New York Heart Association Class I congestive heart failure. In infants, doses less than 5 mcg (0.05 mL) may be necessary. Intranasal: Despite low bioavailability, the pharmacodynamic effects of oral desmopressin were similar in magnitude to those after intravenous dose at night and during the first 6 h after daytime administration. Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. What is the standard conversion technique to calculate those dosages from a typical. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Cortisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 8600 Rockville Pike Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia. Desmopressin is found in breast milk, but not in significant amounts. Management focuses on controlling symptoms with drug therapy. Adjust dose based upon response to treatment estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. Treatment with ddAVP improves platelet-based coagulation in a rat model of traumatic hemorrhagic shock. 1 0 obj Desmopressin, sold under the trade name DDAVP among others, is a medication used to treat diabetes insipidus, bedwetting, hemophilia A, von Willebrand disease, and high blood urea levels. A woman who took both desmopressin and ibuprofen was found in a comatose state. 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. An official website of the United States government. 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. Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. FOIA The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Nonsteroidal antiinflammatory drugs: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Chlorpropamide: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including chlorpropamide. <> Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. 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. Following an intranasal dose of 1.66 mcg of desmopressin for nocturia, the median apparent terminal half-life was 2.8 hours; the half-life range in patients with an eGFR above 50 mL/minute/1.73 m2 was 1.4 to 3.8 hours. For antimicrobial interchanges: the pharmacist must notify the covering provider that the antimicrobial has been converted from IV to PO per protocol. Q@xtt/ Generic Name. Sublingual TabletsThe patient should place the tablet under their tongue 1 hour before bedtime until it dissolves.Have the patient empty their bladder just before bedtime.Advise patients to limit the amount of water or liquids they drink from 1 hour before taking desmopressin sublingual tablet and until 8 hours after. Desmopressin acetate injection is administered as an intravenous infusion at a dose of 0.3 mcg desmopressin acetate/kg body weight diluted in sterile physiological saline and infused slowly over 15 to 30 minutes. Example: Ampicillin-sulbactam 1.5gm IV Q6H to amoxicillin-clavulanic acid 875mg/125mg PO Q12H. Adult dosing should not be used in this age group; adverse events such as hyponatremia-induced seizures may occur. Metolazone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Repeat administration should be determined by laboratory response and clinical condition of the patient. 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. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. May repeat dose if needed. Prior to treatment with DDAVP Injection, verify that factor VIII coagulant activity levels are >5% and exclude severe von Willebrand's disease (Type I) and presence of abnormal molecular form of factor VIII antigen. Monitor blood pressure and pulse during infusion. Furosemide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. Unlike nearly all other benzodiazepine conversions, the conversion between intravenous midazolam and lorazepam has been well studied in mechanically ventilated patients. Blood pressure and heart rate monitoring during infusion is recommended. Desmopressin has also been used in congenital or acquired bleeding disorders, including drug-induced platelet dysfunction (e.g., aspirin, dextran, ticlopidine, and heparin). 2022 Mar 8;7(1):e000852. A systematic review of 30 studies of desmopressin for the treatment and prophylaxis of bleeding disorders in pregnancy (n = 216) concluded that the drug is effective in reducing bleeding complications associated with pregnancy and childbirth with a good safety record. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Lidocaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. However, dose should always be titrated individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) of the patient. Vasopressin also causes constriction of vascular smooth muscle and contraction of smooth muscle in the GI tract and uterus. Preoperative doses may be given 2 hours prior to the scheduled procedure. 0.02 mg IN, 0.2 mg PO and 0.4 mg PO) have a similar, pronounced pharmacodynamic effect on urine volume and urine osmolality. -The most preferred drug is desmopressin acetate (DDAVP), a synthetic form of vasopressin given orally, as a sublingual "melt," or intranasally in a metered spray. Desmopressin increases plasma factor VIII (FVIII) and von Willebrand factor (vWF) to a greater extent than equivalent weights of vasopressin. DDAVP (2 micrograms IV q8hr) is started immediately and continued until the sodium is close to normal. 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. Deflazacort: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 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. 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. Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with 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. Articaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly.

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