Less vasopressor activity. 8-10 mg IV = 40 mg PO. Acetaminophen; 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. During the initial titration period and continued therapy, observe and monitor closely. 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. 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. When switching between formulations, the below text is meant as guidance for starting dose. Desmopressin is a strong V2 agonist and has no effect on V1 receptors. 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. DDAVP will often maintain hemostasis in patients with hemophilia A during surgical procedures and postoperatively when administered 30 minutes prior to scheduled procedure. The plasma levels given by the intravenous dose resulted in a duration of action of 12 h or more. Dosing: Diabetes Insipidus Do not dilute DDAVP Injection for the Diabetes Insipidus population. *L#n~i V3{kf_t.wjO_KgImL%4+GJ+Pp QsWAd._e7p!90&z {c`Kk;swZ/Nf{s~d? Doses may be titrated up to 0.6 mg PO once daily at bedtime, depending on individual patient response. Ensure that serum sodium is normal prior to initiating or resuming treatment with DDAVP Injection. C. The pharmacist must enter Epic order comments stating "IV to PO Conversion per P&T policy for all interchanged orders. Response should be estimated by two parameters: adequate duration of sleep and adequate, not excessive, water turnover. The initial and terminal half-lives for desmopressin are 7.8 and 75.5 minutes, respectively, resulting in a prompt onset of action with a long duration of action. The Melt dose is then derived from tablet conversion, as . -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. IV and subcutaneously: No definitive dosing available. Preoperative doses may be given 2 hours prior to the scheduled procedure. Paediatr Drugs. 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. Oral doses of 0.2 and 0.4 mg produce similar responses on urine volume and urine osmolality as 0.01 mg and 0.02 mg intranasal doses. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. TYPES OF IV TO PO THERAPY CONVERSIONS: There are three types of IV to PO therapy conversions as defi ned below: SEQUENTIAL THERAPY SWITCH THERAPY STEP DOWN THERAPY. Intranasal: 5 to 40 mcg/day divided into 1 to 3 doses. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Blood samples were taken before and at predetermined time points up to 12 h after dosing. 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. Please enable it to take advantage of the complete set of features! Some have suggested an initial dosage range of 0.1 to 1 mcg in 1 or 2 divided doses. Desmopressin is also used to control excessive thirst and the passage of an abnormally large amount of urine that may occur after a head injury or after certain types of surgery. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Conversion of IV Midazolam. Desmopressin is contraindicated in persons with moderate to severe renal impairment (CrCl less than 50 mL/minute or eGFR less than 50 mL/minute/1.73 m2) and renal failure. Desmoperssin is the drug of choice for treatment of central diabetes insipidus and most commonly it is used as intranasal spray. Patients previously receiving intranasal treatment may begin oral therapy the night following (24 hours) the last intranasal dose. DDAVP is also available as nasal spray and tablet dosage forms. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. The site is secure. Caution should be used when coadministering these agents. The comparable antidiuretic dose of the injection is approximately 1/10 the intranasal dose. 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. 1183.34 DDAVP Nasal SprayDDAVP nasal spray delivers doses in 0.1 mL (10 mcg) increments. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia. <>/Metadata 2732 0 R/ViewerPreferences 2733 0 R>> Dose range is 0.1 to 1.2 mg divided into 2 or 3 doses. Deflazacort: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Objective: HONcode standard for trust- worthy health, Pediatric Oncology: Diagnosis And Prognosis Communication. Copyright 2021 GlobalRPH - Web Development by, The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Fifteen healthy men aged 55-70 years were included in the analysis. The study had an open, randomised, four-way cross-over design. Dexamethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. June 30, 2022 by . Infants 3 months of age and children: Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Torsemide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. <> Barnabei A, Corsello A, Paragliola RM, Iannantuono GM, Falzone L, Corsello SM, Torino F. Cancers (Basel). Nabumetone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. 4. However, dose should always be titrated individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) of the patient. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 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. Would you like email updates of new search results? Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 1999 Dec;84 Suppl 1:5-8 Dose: 0.1-1.2 mg/day PO divided bid-tid; Start: 0.05 mg PO bid; Max: 1.2 mg/day; Info: give 1st PO dose 12h after last intranasal dose when switching to PO; restrict fluid intake [parenteral route] Dose: 2-4 mcg/day SC/IV divided qd-bid; Info: parenteral dose is approx. 2 0 obj The patient should close the open nostril with a finger from the empty hand and gently inhale while the nasal applicator is pumped 1 time. Desmopressin is not effective in persons with type 3 von Willebrand's disease (vWD) and can cause platelet aggregation, thrombocytopenia, and possibly thrombosis in persons with type 2B vWD. once BP controlled with IV therapy switch to PO therapy at 200 mg. then 200-400mg 6-12 hours later titrating to effect. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. In general, most reported clinical experience with desmopressin has not identified efficacy response differences between geriatric and younger patients. 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. 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). R8cxz. 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. Desmopressin acetate should not be used to treat patients with Type IIB von Willebrands disease since platelet aggregation may be induced. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Clipboard, Search History, and several other advanced features are temporarily unavailable. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. endobj 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. A woman who took both desmopressin and ibuprofen was found in a comatose state. The previously recommended dose: 20 mcg (0.2 mL) intranasally of the 0.01% nasal solution at bedtime, with one-half of the dose administered into each nostril. 2 mg PO - 15 mg IV. Single-dose administration has been used for uremic bleeding in patients with renal failure; however, repeat doses are not recommended. 14 A commonly cited double-blind trial suggests a conversion of 1 mg IV lorazepam to 2 mg of IV midazolam, which is further supported using a midazolam oral bioavailability of 40% due to a . It is chemically defined as follows: Mol. 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. BJU Int. 3 0 obj The following pharmacist will check on these open i-Vents and close then when appropriate. Triamterene; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Desmopressin acetate 100 microgram Tablet Active Ingredient: desmopressin acetate Company: Aspire Pharma Ltd See contact details ATC code: H01BA02 About Medicine Prescription only medicine Healthcare Professionals (SmPC) Patient Leaflet (PIL) This information is for use by healthcare professionals Last updated on emc: 02 Mar 2022 Quick Links Betamethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. In general, dose selection for the geriatric patient should be cautious, usually starting at the low end of the dosing range. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours. 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. {+/7VPerb}6Wz+>8. Clin Endocrinol (Oxf). The recommended maintenance dose is 10 mcg/day to 40 mcg/day intranasally (0.1 mL/day to 0.4 mL/day) in 1 to 3 divided doses. Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. If the patient was previously receiving desmopressin tablets, dose titration is required because intranasal desmopressin is approximately 10 to 40 fold more potent than oral (tablet) desmopressin. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Fludrocortisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Eprosartan; 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 woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Ibuprofen; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. . This is probably due to saturation of receptor sites. In a male subject with mild Von Willebrand (vW) disease, intravenous infusion of DDAVP 2 hours after administration of oral tolvaptan did not produce the expected increases in vW Factor Antigen or Factor VIII activity. Articaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. -, BJU Int. Prolonged experience with desmopressin in pregnant women over several decades, based on the available published literature and case reports, have not identified a drug associated risk of major birth defects, miscarriage or other adverse maternal or fetal outcomes. Typical maintenance dose was 10 to 40 mcg/day (0.1 to 0.4 mL/day). Adjust doses based on patient's diurnal pattern of response. Q@xtt/ The necessity for repeat administration of desmopressin acetate or use of any blood products for hemostasis should be determined by laboratory response as well as the clinical condition of the patient. Corticosteroids: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. In certain clinical situations, it may be justified to try desmopressin in persons with factor VIII concentrations of 2% to 5%; however, carefully monitor these patients. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. [61810], Initially, 10 mcg (0.1 mL) intranasally, given in 1 to 3 divided doses, then titrated to response. 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. Caution should be exercised when desmopressin is administered to a woman who is breast-feeding. Desmopressin is similar to a hormone that is produced in the body. A woman who took both desmopressin and ibuprofen was found in a comatose state. *Ovv]pu}gz$3 Brompheniramine; 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. Desmopressin nasal spray can be resumed when these conditions resolve. Consider other treatment options for this condition. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Proposed sites of these receptors include endothelial cells, megakaryocytes, blood monocytes, and mast cells. Tricyclic antidepressants: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Bioavailability and pharmacokinetics of desmopressin in elderly men. Initially, 0.05 mg PO twice daily. Initial dose: 0.05 mg orally twice a day or IV Push for Hyperkalemia. The 0.83 mcg dose did not meet all prespecified efficacy endpoints in clinical trials, but may have a lower risk of hyponatremia. Carbetapentane; Chlorpheniramine; 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 Chlorothiazide: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Diphenhydramine; Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 0.1 to 0.4 mL via rhinal tube intranasally twice a day. It may be given in the nose, by injection into a vein, by mouth, or under the tongue. Alternatively, if the patient was previously receiving intranasal therapy, the usual dose is one-tenth (1/10) of the intranasal maintenance dose. In additio [33605], Initially, 10 mcg (0.1 mL) intranasally, given in 1 to 3 divided doses, then titrated to response. 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. A woman who took both desmopressin and ibuprofen was found in a comatose state. About 1/4 to 1/3 of patients can be controlled by a single daily dose. The risk of toxic reactions (including water intoxication and low sodium concentrations) appears to be greater in the geriatric patient and other patients with impaired renal function. Do not use desmopressin as sole therapy in persons with vWD undergoing major surgery. 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. Repeat administration should be determined by laboratory response and clinical condition of the patient. Use in children requires careful fluid intake restrictions to prevent possible hyponatremia and water intoxication. Reassess patient after the initial 24 hours; if clinical status has improved may begin gradually tapering the dose. Longer DOA. The recommended starting dose is 1 spray (0.83 mcg) in either the left or right nostril approximately 30 minutes before going to bed. Beclomethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Bookshelf Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. They should also avoid drinks containing caffeine and alcohol before bedtime. Saint-Prex, Switzerland - 21 June, 2022 - Minirin (desmopressin) Nasal Spray 0.1 mg/ml room temperature stable (RTS)/ Octostim (desmopressin) Nasal Spray 1.5 mg/ml/ DDAVP (desmopressin acetate, 10 mcg/0.1 mL)/ Stimate (desmopressin acetate, 1.5 mg/1 mL) Nasal Spray/ Generic Desmopressin Acetate (10 mcg/0.1mL) Nasal Spray - Recall and Production Hold Statement 3 months and older: Dependent on route of administration and indication for therapy.Less than 3 months: Safety and efficacy have not been established. 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. Results: A woman who took both desmopressin and ibuprofen was found in a comatose state. documenting the conversion using the "IV to PO conversion" category. Desmopressin Stimulates Nitric Oxide Production in Human Lung Microvascular Endothelial Cells. Dose range is 0.1 to 0.8 mg daily. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Oxybutynin: (Major) Hyponatremia-induced convulsions have been rarely reported when oxybutynin and desmopressin are used concomitantly. Fluid intake restrictions in these patients are recommended. Desmopressin (dDAVP), a synthetic analogue of 8-arginine vasopressin (ADH), is an antidiuretic . In patients receiving desmopressin nasal spray for nocturia, discontinue treatment in patients with concurrent nasal conditions that may increase systemic absorption of desmopressin (e.g., atrophy of nasal mucosa, and acute or chronic rhinitis), because the increased absorption may increase the risk of hyponatremia. Thiazide diuretics: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Bumetanide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. Oral to IV Conversion: The intravenous dose of levothyroxine is not the same as the oral dose. Fluticasone; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. 1 0 obj Ethacrynic Acid: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. For antimicrobial interchanges: the pharmacist must notify the covering provider that the antimicrobial has been converted from IV to PO per protocol. For patients who have been controlled on intranasal desmopressin acetate and who must be switched to the injection form, either because of poor intranasal absorption or because of the need for surgery, the comparable antidiuretic dose of the injection is about one-tenth the intranasal dose.
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