Desmopressin may be used throughout pregnancy for the treatment of diabetes insipidus (Aleksandrov 2010; Ananthakrishnan 2016; Brewster 2005; Schrier 2010). IV: Infants 3 months, Children, and Adolescents: 0.3 mcg/kg; if used preoperatively administer 30 minutes before procedure; may repeat dose if needed. Digoxin in single 1 bolus dose < 0.5 mg (Lanoxin) IV Push* IV Push* IV Push* *Slow IV injection over 5 minutes or longer. IM, IV, SubQ: Canadian labeling (DDAVP Injection only): 1 to 4 mcg (0.25 to 1 mL) once daily or one-tenth (1/10) of the maintenance intranasal dose. DDAVP injection: Hemophilia A and von Willebrand disease (type 1): Dilute solution for injection in 50 mL NS for IV infusion. For 10 mcg dose, administer in one nostril. Use of Desmopressin acetate injection with other vasoconstrictors may require a reduction of the Desmopressin acetate injection dosage [see Warnings and Precautions (5.2), Adverse Reactions (6)]. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Intermittently during treatment, assess serum sodium, urine volume and osmolality or plasma osmolality. DDAVP Rhinal tube: Insert top of dropper into tube (arrow marked end) in downward position. Canadian labeling: Additional contraindications (not in US labeling): Note: May not be applicable to all available dosage forms; refer to manufacturer labeling for further detail. This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. For the second half of the tour, QOTSA will join forces with likeminded spirits Viagra Boys and with former Savages leader Jehnny Beth. Nocturia (Noctiva): Treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void. Manufactured by: Monitor therapy, Opioid Agonists: May enhance the adverse/toxic effect of Desmopressin. Last updated February 8, 2020. It is not known whether antibodies to Desmopressin acetate injection are produced after repeated injections. Subcutaneous (not approved for use in the United States): 0.3 mcg/kg (maximum 20 mcg) subcutaneously. Metabolism Diabetes insipidus: Antidiuretic replacement therapy in the management of central diabetes insipidus; management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region. [see Contraindications (4), Clinical Pharmacology (12.3)]. Known hypersensitivity to desmopressin or any component of the formulations; hyponatremia or a history of hyponatremia. It is used to treat von Willebrand disease. Hyponatremia (adjunct to hypertonic saline infusion to prevent overly rapid sodium correction) (off-label use): Note: Desmopressin should only be used as adjunctive therapy to hypertonic saline in patients with severe hyponatremia (<120 mEq/L) due to rapidly reversible causes (eg, hypovolemia) who are likely to develop water diuresis during the course of therapy or in those who are at high risk of osmotic demyelination syndrome. Preserve in tight containers, protected from light. Solution, Injection, as acetate [preservative free]: DDAVP: 0.01% (5 mL) [contains benzalkonium chloride], DDAVP Rhinal Tube: 0.01% (2.5 mL) [contains chlorobutanol (chlorobutol)], Stimate: 1.5 mg/mL (2.5 mL) [contains benzalkonium chloride]. The safety and effectiveness of Desmopressin acetate have not been established in infants less than 3 months of age with hemophilia A or von Willebrands disease or pediatric patients under 12 years of age with diabetes insipidus. In vitro studies demonstrate poor placental transfer of desmopressin. Nasal spray: Store at 15C to 25C (59F to 77F). compensatory increase in heart rate. Supplied: 4 mcg/ml-1 ml vial. Also assess serum sodium and aPTT prior to treatment. Intracranial hemorrhage associated with certain antiplatelet agents (aspirin, clopidogrel, prasugrel, ticlopidine, ticagrelor, cangrelor) (off-label use): IV: 0.4 mcg/kg once (NCS/SCCM [Frontera 2016]). This site complies with the HONcode standard for trust- worthy health information: verify here. For injection use only. May administer with or without food. This information is not specific medical advice and does not replace information you receive from the healthcare provider. Desmopressin is not recommended for nocturia caused by normal physiologic changes which occur during pregnancy. No in vivo interaction studies have been performed with Desmopressin acetate injection. Graham Head, 66, who kidnapped and tried to rape two women, was caught after one victim remembered three digits of his car registration. Desmopressin acetate is contraindicated in patients with moderate to severe renal impairment (defined as a creatinine clearance below 50 mL/min) [see Contraindications (4), Use in Specific Populations (8.6), Clinical Pharmacology (12.3)]. [see Warnings and Precautions (5.1), Drug Interactions (7.1)], Use in Specific Populations (8.4, 8.5)]. Based on the Neurocritical Care Society and the Society of Critical Care Medicine guideline for reversal of antithrombotics in intracranial hemorrhage, desmopressin intravenous is suggested and may be considered in intracranial hemorrhage associated with certain antiplatelet agents (eg, aspirin, clopidogrel, prasugrel, ticlopidine, ticagrelor, cangrelor). Fluid restriction should be observed. Desmopressin may rarely cause severe allergic reactions, including anaphylaxis. Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb. Permanently discontinue for serious hypersensitivity reaction [see Adverse Reactions (6)]. If using preoperatively, administer 2 hours before surgery. Sublingual: Nocdurna: Note: Dosage expressed as desmopressin acetate. A maximum IV dose of 20 mcg has been recommended (DDAVP injection Canadian product labeling). Talk to your doctor if you have questions. Max: 5 mg/dose . WARNING: HYPONATREMIA The only drawback to the DDAVP clamp technique is that this requires the use of a continuous infusion of 3% saline to bring up the sodium concentration. Oral: Children 4 years and Adolescents: Initial: 0.05 mg twice daily; titrate to desired response; optimal daily dose range: 0.1 to 0.8 mg/day in 2 to 3 divided doses; reported daily dose range: 0.1 to 1.2 mg/day. DDAVP nasal spray (10 mcg/spray): Note: The nasal spray pump can only deliver fixed doses in 10 mcg (0.1 mL) increments; if doses other than this are needed, the rhinal tube delivery system is preferred. Note: A test dose to measure response is recommended prior to initiating therapy. Nasal spray. Cosyntropin (Cortrosyn) Use of Desmopressin acetate injection without concomitant reduction of fluid intake may lead to fluid retention and hyponatremia. More frequently monitor serum sodium in patients 65 years of age and older and in patients at increased risk of hyponatremia, [see Dosage and Administration (2.1) and Warnings and Precautions (5.1)], If hyponatremia occurs, Desmopressin acetate may need to be temporarily or permanently discontinued. Desmopressin acetate 27.7 mcg is equivalent to desmopressin (base) 25 mcg. Limitations of use: Not indicated for the treatment of hemophilia A with factor VIII coagulant activity levels 5%, for the treatment of hemophilia B, or in patients who have factor VIII antibodies. Note: 2 sprays of 0.83 mcg/0.1 mL are not interchangeable with 1 spray of 1.66 mcg/0.1 mL; do not administer 2 sprays of the 0.83 mcg/0.1 mL product. DDAVP: Nasal pump spray: Delivers 0.1 mL (10 mcg); for doses <10 mcg or for other doses which are not multiples, use rhinal tube. Hyderabad-502 307, India. The volume of diluent is weight-based. Hypersensitivity reactions including anaphylaxis have been reported with intravenous and intranasal Desmopressin acetate, including cases of fatal anaphylaxis with intravenous Desmopressin acetate. The estimated background risk of major birth defects and miscarriage for the indicated population are unknown. Treatment period is up to 3 months and then reassess with 1 week off treatment; if additional therapy is necessary, resume at same dosage prior to discontinuation. Base the frequency of serum sodium monitoring on the patients risk of hyponatremia. Note: Hyponatremia is listed as a contraindication for use of desmopressin in some instances. Dilute Desmopressin acetate injection in sterile 0.9% Sodium Chloride Injection, USP and infuse slowly over 15 minutes to 30 minutes. Most adults require 10 mcg (0.1 mL) twice daily. 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. Protect from moisture. Surgical bleeding in patients with uremia (prevention)a. However, dose should always be titrated individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) of the patient. Avoid combination, Corticosteroids (Orally Inhaled): May enhance the hyponatremic effect of Desmopressin. The percentage increase of factor VIII levels in patients with mild hemophilia A and von Willebrands disease was not significantly different from that observed in normal healthy individuals when treated with 0.3 mcg/kg of Desmopressin acetate infused over 10 minutes. dilution, reconstitution, or the safe rate of administration of IV push medications Risks Associated with Drug Labeling, Packaging, and Nomenclature IV medications that are prepared in empty sterile syringes, but left unlabeled IV push medications that are prepared (diluted, reconstituted) in commercially available syringes of 0.9% sodium Data from a limited number of patients (case series) who were experiencing hemorrhage in the setting of renal insufficiency suggests that IV desmopressin may be beneficial for the treatment of this condition Watson 1984a. The change in structure of arginine vasopressin to Desmopressin acetate resulted in increased duration of action and a decreased vasopressor action and decreased actions on visceral smooth muscle relative to the enhanced antidiuretic activity, so that clinically effective antidiuretic doses were usually below threshold levels for effects on vascular or visceral smooth muscle. In certain clinical situations, it may be justified to try Desmopressin acetate in patients with factor VIII levels between 2% to 5%; however, these patients should be carefully monitored. Ensure the serum sodium concentration is normal before starting or resuming Desmopressin acetate. Monitor patients for signs or symptoms of hypersensitivity reactions during administration, interrupt treatment should a reaction occur, and manage medically. Intranasal: Ensure that nasal passages are intact, clean, and free of obstruction prior to administration. Below, check out the tour dates, as well as a weird tour . Discard unused portion. Monitor serum sodium more frequently in patients taking Desmopressin acetate injection concomitantly with these drugs and when doses of these drugs are increased [see Contraindications (4), Warnings and Precautions (5.1), Drug Interactions (7.1), Use in Specific Populations (8.4, 8.5)]. Wt. Products used for the treatment of nocturia are specifically contraindicated in patients with polydipsia. 0.83 mcg in either nostril nightly ~ 30 min before going to bed; 0.83 mcg dose may have a lower risk of hyponatremia; may be increased to 1 spray of 1.66 mcg after at least 7 days, if needed, provided serum sodium has remained normal. Canadian labeling: Children 5 years and Adolescents: Initial: 0.2 mg once before bedtime; may titrate by 0.2 mg/day every 3 days as needed to a maximum dose of 0.6 mg/day; fluid intake should be limited to a minimum from 1 hour before desmopressin administration until the next morning, or at least 8 hours after administration. IV, SubQ: 1 to 2 mcg every 6 to 8 hours for 24 to 48 hours or until serum sodium increases to 125 mEq/L (Sood 2013; Sterns 2018). Desmopressin Acetate Injection 4 mcg/mL dosage must be determined for each patient and adjusted according to the pattern of response. 1-(3-mercaptopropionic acid)-8-D-arginine vasopressin monoacetate (salt) trihydrate. Cardiovascular: Hypertension, hypotension, tachycardia, thrombotic events, fluid retention von Willebrand disease type 2B: Patients with type 2B von Willebrand disease requiring hemostasis should not be treated with desmopressin since may result in platelet aggregation, thrombocytopenia, and possibly thrombosis. 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. Noctiva: Do not shake. Spray is then ready for use. Limitations of use: Not indicated for the treatment of severe classic von Willebrand disease (type 1) or when there is evidence of an abnormal molecular form of factor VIII antigen. Avoid combination, Demeclocycline: May diminish the therapeutic effect of Desmopressin. Reduce bleeding with episodes of spontaneous or traumatic injuries such as hemarthroses, intramuscular hematomas, or mucosal bleeding. Following dilution in NS may store at room temperature for up to 24 hours. [see Contraindications, Warnings and Precautions (5.1)]. Hyponatremia (adjunct to hypertonic saline infusion to prevent overly rapid sodium correction)c. Data from a limited number of patients (case series) with severe hyponatremia (serum sodium <120 mEq/L) suggest that treatment with desmopressin as an adjunct to hypertonic saline may be beneficial for preventing overly rapid correction of hyponatremia MacMillan 2015, Sood 2013. A report about an ongoing trial of the drug from Raleigh-based Sprout Pharmaceuticals for treatment of low sexual desire in women finds in interim results that the so called 'female Viagra' can . Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat. Patients with conditions associated with fluid and electrolyte imbalance (i.e., cystic fibrosis, heart failure, and renal disorders), geriatric and pediatric patients, patients receiving concomitant treatments that also cause hyponatremia (i.e., tricyclic antidepressants, selective serotonin reuptake inhibitors, nonsteroidal anti-inflammatory drugs, chlorpromazine, opiate analgesics, carbamazepine, lamotrigine, thiazide diuretics and chlorpropamide), and patients with habitual or psychogenic polydipsia who may drink excessive amounts of water, may be at increased risk of hyponatremia [see Contraindications (4)]. Hemophilia A: For use in patients with hemophilia A with factor VIII coagulant activity levels >5% to maintain hemostasis during surgical procedures and postoperatively when administered 30 minutes prior to the scheduled procedure and to also stop bleeding due to spontaneous or trauma-induced injuries, such as hemarthroses, intramuscular hematomas, or mucosal bleeding. If spray pump is not used for 48 hours it must be primed again by pressing down a couple of times until an even spray appears. Drug class: Antidiuretic hormones. Available for Android and iOS devices. Moderate to severe renal impairment defined as a creatinine clearance below 50 mL/min, Hyponatremia or a history of hyponatremia, Known or suspected syndrome of inappropriate antidiuretic hormone (SIADH) secretion, Concomitant use with systemic or inhaled glucocorticoids, During illnesses that can cause fluid or electrolyte imbalance, such as gastroenteritis, salt-wasting nephropathies, or systemic infection, Increased risk of thrombosis in patients with von Willebrands Disease Type IIB, Inform patients that Desmopressin acetate may cause severe hyponatremia, which may be life-threatening, if it is not promptly diagnosed and treated, Inform them about the signs and symptoms associated with hyponatremia, to undergo recommended serum sodium measurements, and to inform their health care provider about new medications. SubQ: Octostim [Canadian product]: May administer undiluted by direct injection. 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