DDAVP aka Desmopressin
[1 vial $6.72]
- IV, IM, SC, Intranasal
- Minirin, octostim
- treatment of central diabetes insipidus
- prevention and control of bleeding (primarily when there are thought to be platelet function defects especially uraemia, clopidogrel or cardiopulmonary bypass -related)
PRESENTATION AND ADMINISTRATION:
Minirin 4mcg/ml injection
Octostim 15mcg/ml injection
Doses of 4mcg or less should be administered undiluted by direct IV injection.
For small doses (eg 0.4mcg), 4mcg can be diluted in 10 ml of normal saline. For doses of greater than 4mcg in adults or children weighing more than 10kg, dilute with 50ml of normal saline and infuse the first 5ml slowly over 5 minutes. For children weighing less than 10kg, dilute in 10ml of normal saline and infuse the first 1-2ml over 5 minutes. If no marked tachycardia or other adverse effects are observed, give the remainder slowly over 15 minutes
Minirin 0.1mg tablets (white)
- Nasal Spray:
Desmopressin spray (10mcg/dose), Minirin spray (10mcg/dose), Octostim (150mcg/ dose)
Central diabetes insipidus:
0.4mcg repeated as required (may increase the dose if there is an adequate response)
Prevention and control of bleeding:
0.3mcg/kg (max 24mcg) over 30 minutes (once only) Note: although IM and SC routes can be used, IV is generally the preferred route.
0.1mg -1.2mg daily depending on indication (rarely used by this route in ICU)
- Nasal Spray:
Not generally administered by this route in ICU
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
- Dose as in normal renal function
- Desmopressin is a synthetic analogue of the natural pituitary hormone arginine vasopressin (ADH), an antidiuretic hormone affecting renal water conservation..
- hypersensitivity to desmopressin
- When desmopressin acetate injection is administered to patients who do not have need of antidiuretic hormone for its antidiuretic effect, in particular in paediatric and geriatric patients, fluid intake should be adjusted downward to decrease the potential occurrence of water intoxication and hyponatremia. Particular attention should be paid to the possibility of the rare occurrence of an extreme decrease in plasma osmolality that may result in seizures which could lead to coma.
Desmopressin acetate injection has infrequently produced changes in blood pressure causing either a slight elevation in blood pressure or a transient fall in blood pressure and a compensatory increase in heart rate. The drug should be used with caution in patients with coronary artery insufficiency and/or hypertensive cardiovascular disease. There have been rare reports of thrombotic events following desmopressin acetate Severe allergic reactions have been reported rarely. Anaphylaxis has been reported rarely with desmopressin.
- Laboratory Tests:
Laboratory tests for monitoring the patient include urine volume and osmolality. In some cases, plasma osmolality may be required.
- Drug/Laboratory Test Interactions:
None of note
IMPORTANT DRUG INTERACTIONS FOR THE ICU
- DDAVP may cause minor increases in blood pressure requiring changes in levels of vasopressor support.
- Central Nervous System:
transient headache, ischaemic stroke
- Cardiovascular System:
changes in blood pressure causing either a slight elevation or a transient fall and a compensatory increase in heart rate, myocardial infarction Gastrointestinal System: nausea, mild abdominal cramps
- Metabolic and Endocrine System:
water intoxication and hyponatremia.
Local irritation at site of injection