Persons with renal disease may be at increased risk for low sodium concentrations, fluid overload, and electrolyte abnormalities. 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. The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced. If the patient was previously receiving desmopressin injection, administer 10 times the amount of desmopressin acetate, rounding down to the nearest 10 mcg. Adjust dose based upon response to treatment estimated by two parameters: adequate duration of sleep and adequate, not excessive, water turnover. Nabumetone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. In certain clinical situations, it may be justified to try DDAVP in patients with factor VIII levels between 2% to 5%; however, these patients should be carefully monitored. BJU Int. If 30 mcg is divided, typically 20 mcg is given in the morning, and 10 mcg is given at night. Treatment nave patients: The recommended starting daily dosage is 2 mcg to 4 mcg administered as one or two divided doses by subcutaneous or intravenous injection. Amiodarone (Cordarone) IV Infusion IV Infusion IV Infusion: A-fib rate control only . PATIENTS NOT AT INCREASED RISK FOR HYPONATREMIA: 1 spray (1.66 mcg) in either the left or right nostril approximately 30 minutes before going to bed. dose conversion. 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. Carbetapentane; 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. 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. Only start or resume therapy in patients with a normal serum sodium concentration. Diabetes Insipidus: < 12 years: No definitive dosing available. Opiate Agonists: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Single-dose administration has been used for uremic bleeding in patients with renal failure; however, repeat doses are not recommended. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 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. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Ibuprofen; Famotidine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. 2020 Aug;22(4):369-383. doi: 10.1007/s40272-020-00401-7. A woman who took both desmopressin and ibuprofen was found in a comatose state. 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. DDAVP is also available as nasal spray and tablet dosage forms. The pump will stay primed for up to 1 week. If patient responded to 20 mcg/day, the dose was adjusted downward to 10 mcg/day to see if response could be maintained. Do not dilute DDAVP Injection for the Diabetes Insipidus population. Patients previously receiving intranasal treatment may begin oral therapy the night following (24 hours) the last intranasal dose. Fluticasone; Umeclidinium; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. In addition, in vitro studies with human placenta demonstrate poor placental transfer of desmopressin. If doses other than these are required, parenteral desmopressin injection must be used.One spray (150 mcg) has an antidiuretic activity of about 600 International Units.The nasal spray must be primed prior to first use. If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. Children younger than 12 years of ageUse and dose must be determined by your doctor. Background. Adults and children 12 years of age and older0.5 to 1 milliliter (mL), divided into 2 doses and injected under the skin in the morning and evening. Put the other end of the tube into the patients mouth; the patient should hold their breath.Tilt the patient's head back and have them blow with a short strong puff through the tube. A woman who took both desmopressin and ibuprofen was found in a comatose state. Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Persons with vWD subtype 1C, which is characterized by a shorted vWF half-life, may require alternative management in the setting of surgery. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Monoamine oxidase inhibitors: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia and SIADH including monoamine oxidase inhibitors (MAOIs). Desmopressin acetate 200 microgram tablets; 10microgram/mL WCHN prepared solution; 4microgram/mL injection solution - SA Neonatal Medication Guidelines | SA Health Medication guideline for the management of neonates requiring desmopressin acetate. Permanently discontinue for serious hypersensitivity reaction. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Withdraw the necessary volume of DDAVP Injection from the vial and dilute by adding to the infusion bag of 0.9% Sodium Chloride Injection, USP per Table 1. To prime, press down 4 times. Lansoprazole; Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Although the manufacturer states that nasal congestion does not affect the absorption of intranasal desmopressin, some clinicians recommend a higher dose. Longer DOA. Beclomethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Other evaluations have indicated that the terminal half-life for desmopressin is approximately 3 hours. Use this combination with caution, and monitor patients for signs and symptoms of hyponatremia. Chlorpheniramine; Dextromethorphan; 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. Carbetapentane; Guaifenesin; 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. This is probably due to saturation of receptor sites. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia 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. Adjust treatment according to the diurnal pattern of response. Twist off the seal from the dropper. 4 0 obj Atenolol; Chlorthalidone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Initiate at low dose and increase as necessary. Infants 3 months of age to children 12 years of age: Pharmacokinetics and pharmacodynamics in clinical use of scopolamine. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Preoperative doses may be given 2 hours prior to the scheduled procedure. DDAVP will often maintain hemostasis in patients with hemophilia A during surgical procedures and postoperatively when administered 30 minutes prior to scheduled procedure. If the patient was previously receiving desmopressin injection, administer 10 times the amount of desmopressin acetate, rounding down to the nearest 10 mcg. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Last updated on Apr 7, 2022. Patients receiving intranasal treatment could begin oral therapy the night following (24 hours) the last intranasal dose. 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. The initial response is reproducible if DDAVP is administered every 2 to 3 days. DOSAGE AND ADMINISTRATION Hemophilia A and von Willebrand's Disease (Type I): Desmopressin Acetate Injection 4 mcg/mL 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. Greatly enhanced ADH activity. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia, which may include monitoring serum sodium or electrolytes periodically. Preoperative IV doses may be given 30 minutes prior to scheduled procedure. 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 Before The comparable antidiuretic dose of the injection is approximately 1/10 the intranasal dose. 1998 Nov;82(5):642-6 The mean (+/- S.D.) Response should be estimated by 2 parameters, adequate duration of sleep and adequate, not excessive, water turnover. -, Br J Clin Pharmacol. A comparison was made of intranasal administration of 300 micrograms desmopressin (DDAVP) by spray, with intravenous administration of 0.2, 0.3 and 0.4 microgram DDAVP/kg in 10 healthy volunteers. Increased FVIII and vWF levels are thought to be due to their release from endogenous reservoirs and not increased synthesis since the response is so rapid. 50 kg or less: 150 mcg Etodolac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. The pump will stay primed for up to 1 week. Grading Central Diabetes Insipidus Induced by Immune Checkpoint Inhibitors: A Challenging Task. 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 Chlorothiazide: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. When DDAVP /Desmopressin Injection is used for diagnostic purposes, fluid intake must be limited and not exceed 0.5 litres from 1 hour before until 8 hours after administration. The following pharmacist will check on these open i-Vents and close then when appropriate. Adult dosing should not be used in this age group; adverse events such as hyponatremia-induced seizures may occur. Ensure the patient is compliant with fluid restrictions and intake. 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. Guardrail Drug Requires documentation of two (2) RN's for double-checking. Desmopressin systemic 0.1 mg (232 0.1 barr). It is not known if the drug is metabolized; however, in contrast to vasopressin, desmopressin does not appear to be degraded by the peptidase enzymes responsible for metabolizing endogenous vasopressin during the last trimester of pregnancy. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Do Not Copy, Distribute or otherwise Disseminate without express permission. 4 0 obj Desmopressin was administered orally (0.2 mg) and intravenously (2 microg), daytime and night-time, yielding four in-hospital sessions, separated by at least 2 days. For children weighing less than 10 kg, dilute dose in 10 mL 0.9% Sodium Chloride for injection.Infuse IV slowly over 15 to 30 minutes.Pulse and blood pressure should be monitored during infusion. To investigate (1) the pharmacokinetic and pharmacodynamic profiles of desmopressin in men from an age group with a high incidence of nocturia; and (2) circadian variation in the pharmacokinetic parameters. 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. If patients are receiving intranasal therapy, begin oral therapy 12 hours after the last intranasal dose. Accessibility 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. So, if a patient is on a nasal (spray or intranasal) dose of 10mcg (0.1 ml) twice a day, then a suitable tablet oral dose may be 100mcg or 200mcg twice a day. Dopamine: (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 dopamine only with careful patient monitoring. In the elderly, careful dosage selection and monitoring of renal function are recommended. Response should be estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. Preserve in tight containers, protected from light. endobj Dosage adjustments of desmopressin may be necessary to maintain proper sodium and water balance. eCollection 2022. Ddavp, Nocdurna, Octostim. official website and that any information you provide is encrypted The effect of DDAVP was measured on F VIII/vWF complex and on plasminogen activator release. endobj Wash the rhinal tube in water and shake well, until no water is left in the tube.To avoid the spread of infection, do not use the container for more than 1 person.For 2.5 mL bottles, discard after 25 sprays (doses) because the amount delivered thereafter per spray may be substantially less than the recommended dose. 2005 Oct;27(5):655-65. doi: 10.1097/01.ftd.0000168293.48226.57. Maximal dose-response increase in Factor VIII activity occurs at 0.3 to 0.4 mcg/kg desmopressin. Careful fluid intake restrictions are required to prevent hyponatremia and water intoxication. 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. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Acetaminophen; Chlorpheniramine; Dextromethorphan; 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. Intranasal desmopressin 300 mcg results in maximal Factor VIII and von Willebrand Factor activity levels 150% to 250% of 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. Mometasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb. Drugs; . Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. [61810], Initially, 5 mcg (0.05 mL) intranasally, given in 1 to 2 divided doses, then titrated to response. Torsemide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. Furosemide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. 1.2 mg/day PO, 4 mcg/day SC/IV; Alt: 2-4 mcg/day SC/IV divided qd-bid; Info: give 1st PO dose 12h after last intranasal dose when switching to PO; parenteral dose is approx. Last updated on Sep 28, 2022. For bleeding, desmopressin increases the blood levels of factor VIII and von Willebrand . The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Methyclothiazide: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. The study had an open, randomised, four-way cross-over design. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Amlodipine; Valsartan; 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. Please enable it to take advantage of the complete set of features! doi: 10.31744/einstein_journal/2023RC0124. However, dose should always be titrated individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) of the patient. 2 0 obj DDAVP Nasal Spray (desmopressin acetate) Rx only DESCRIPTION DDAVP Nasal Spray (desmopressin acetate) is a synthetic analogue of the natural pituitary hormone 8-arginine vasopressin (ADH), an antidiuretic hormone affecting renal water conservation. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. If the product has not been used for a period of 1 week, re-prime the pump by pressing once.Instruct patient on the proper technique for administering the nasal spray. A woman who took both desmopressin and ibuprofen was found in a comatose state. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. What is the difference in Nocdurna dosage between men and women. Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. IV: 1 to 2 mcg twice a day ADH activity : Pressor activity [DDAVP: 2000-4000: 1 Vasopressin: 1:1]. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. %PDF-1.7 Oral to IV Conversion: The intravenous dose of levothyroxine is not the same as the oral dose. Children more than 12 years of age: This site needs JavaScript to work properly. The tendency toward tachyphylaxis (lessening of response) with repeated administration given more frequently than every 48 hours should be considered in treating each patient. Desmopressin is a man-made form of vasopressin and is used to replace a low level of vasopressin. Methods: The study had an open, randomised, four-way cross-over design. Promethazine; 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. Conversion from injection to intranasal: Administer 10 times the amount of desmopressin acetate, rounded down to the nearest 10 mcg. National Library of Medicine 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. Pretreatment Testing and On-Treatment Monitoring Diabetes Insipidus Prior to treatment with DDAVP, assess serum sodium, urine volume and osmolality. If used preoperatively, administer 30 minutes before surgery. When switching from DDAVP Tablets to DDAVP Injection, titrate dose individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) due to the large variability in both PK and PD. [33605], Initially, 10 mcg (0.1 mL) intranasally, given in 1 to 3 divided doses, then titrated to response. Fluid restriction should be observed, and fluid intake should be limited to a minimum from 1 hour before administration, until the next morning, or at least 8 hours after administration. This increase is dose-dependent, with an IV dosage of 0.4 mcg/kg producing a 300% to 400% maximum increase in Factor VIII activity. Blood pressure and heart rate monitoring during infusion is recommended. Fatal anaphylaxis has been reported with intravenous desmopressin. Closely monitor serum sodium levels and urine output; fluid restriction is recommended. IV injection due to hypotension, bradycardia, and arrhythmias. IV Push for Hyperkalemia. A woman who took both desmopressin and ibuprofen was found in a comatose state. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Sumatriptan; Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Drug class: Antidiuretic hormones. Desmopressin is primarily excreted in the urine, with a significant portion excreted as unchanged drug (65% after oral and 92% after intranasal administration). Patients previously receiving intranasal treatment may begin oral therapy the night following (24 hours) the last intranasal dose. If doses other than these are required, the rhinal tube delivery system may be used.One spray (10 mcg) has an antidiuretic activity of about 40 International Units.The nasal spray must be primed prior to first use. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The Melt dose is then derived from tablet conversion, as . 2023 Feb 10;21:eRC0124. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Desmoperssin is the drug of choice for treatment of central diabetes insipidus and most commonly it is used as intranasal spray. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Dosage: (For neonatal dosages, refer to Neonatal IV Drug Manual.) Example: Ampicillin-sulbactam 1.5gm IV Q6H to amoxicillin-clavulanic acid 875mg/125mg PO Q12H. 50 kg or less: 150 mcg Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Infusion Pump Required. celebrity wifi packages cost. No statistically significant differences were detected between night and day except for terminal half-life, which was 3.1 h at night and 2.8 h in the daytime (P=0.02). Articaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. endobj Bumetanide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. If there is no response, the medication will be stopped. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Desmopressin is present in small amounts in human milk and is poorly absorbed by an infant. Factors associated with mortality of myxedema coma: report of eight cases and literature survey. Carbamazepine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including carbamazepine. Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. If used preoperatively, administer 30 minutes prior to the procedure. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Guidelines describe preemptive desmopressin administration to prevent sodium overcorrection. Interrupt therapy for acute illness (e.g., systemic infection, fever, recurrent vomiting or diarrhea), extremely hot weather, vigorous exercise, or other conditions associated with increased water intake. Dose range is 0.1 to 1.2 mg divided into 2 or 3 doses. A woman who took both desmopressin and ibuprofen was found in a comatose state. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. A woman who took both desmopressin and ibuprofen was found in a comatose state. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Diclofenac; Misoprostol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs.

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