Desmopressin

Brands

DEA Class; Rx

Common Brand Names; DDAVP, Stimate, Minirin, Noctiva, Nocdurna

  • Vasopressin-Related

Synthetic structural analog of vasopressin (antidiuretic hormone or ADH); more potent and much longer acting than vasopressin; many dosage forms including oral, injectable, sublingual, and intranasal forms
Used for the treatment of central diabetes insipidus, primary nocturnal enuresis (PNE), spontaneous bleeding or trauma-induced hemorrhage, bleeding prophylaxis (e.g., surgical bleeding), hemophilia A or mild to moderate von Willebrand’s disease, and nocturia due to nocturnal polyuria in adults
The intranasal formulation is no longer indicated to treat PNE secondary to reports of hyponatremic-related seizures sometimes resulting in death

Indicated as antidiuretic replacement therapy in the management of central cranial diabetes insipidus and for management of the temporary polyuria and polydipsia following head trauma or surgery

For the management of patients with central diabetes insipidus (neurohypophyseal diabetes insipidus) including polydipsia and polyuria which occurs after head surgery or trauma.
For the treatment of primary nocturnal enuresis.
For bleeding prophylaxis and prevention and control of surgical bleeding or spontaneous or traumatic hemorrhage in patients with hemophilia A or mild to moderate classic von Willebrand’s disease (type 1) and factor VIII activity concentrations more than 5%.
For the treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void.
For the treatment of symptomatic hyponatremia or hyponatremia overcorrection.
For the treatment of uremic bleeding.

Hypersensitivity

Hyponatremia or history of hyponatremia

Moderate to severe renal impairment (CrCl <50 mL/min)

Nocdurna

  • Dry mouth, men (14%)
  • Dry mouth, women (12%)
  • Headache (2-5%)
  • Hyponatremia, men (4%)
  • Headache, men (4%)
  • Hyponatremia, women (3%)
  • Dizziness, men (3%)
  • Dizziness (3%)
  • Epistaxis (2-3%)
  • Headache, women (2%)
  • Dizziness, women (2%)

Nasal spray

  • Rhinitis (3-8%)
  • Abdominal pain (2%)
  • Asthenia (2%)
  • Chills (2%)
  • Nostril pain (2%)
  • Gastrointestinal disorder (2%)
  • Nausea (2%)
  • Conjunctivitis (2%)
  • Eye edema (2%)
  • Lachrymation disorder (2%)

Abnormal blood pressure (infrequent)

Increased heart rate

Increased blood pressure

Flushing

Seizure (rare)

Hyponatremia

Hyposmolality (rare)

Water intoxication syndrome

Thromboembolic disorder

Allergic reaction (acute)

Anaphylaxis (rare)

Noctiva

  • Nasal discomfort
  • Nasal congestion
  • Atrial fibrillation
  • Dizziness
  • Dyuria

Factor VIII levels <5% or presence of factor VIII antibodies

Avoid use in Type IIB von Willebrand disease

Therapeutic effect has not been observed in patients who have been febrile or stressed for several days; monitor for efficacy if necessary

Use caution in patients with habitual or psychogenic polydipsia (increased risk of hypnatremia)

Risk of potentially fatal hyponatremia/seizures; may occur with any route of administration

Anaphylactic reactioins reported (rare) with IV and intranasal administration

Use alternative route of administration if changes in the nasal mucosa resulting from edema or scarring occurs

Rapid IV infusions may result in severe hypotension

Interrupt therapy if patient perform activities associated with increase in water consumption or with acute illness including fever or recurrent vomiting or diarrhea

Use with caution in patients predisposed to thrombus formation; acute myocardial infarction and cerebrovascular thrombosis reported with desmopressin injection

Therapy can cause fluid retention, which can worsen underlying conditions that are susceptible to volume status, including congestive heart failure (see Contraindications)

In children and the elderly adjust fluid intake downward to decrease possibility of water intoxication and hyponatremia

Prolonged experience with desmopressin in pregnant women over several decades, based on available published data and case reports, did not identify a drug associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

Desmopressin is present in small amounts in human milk and is poorly absorbed orally by infant

Adults

Dependent on route of administration and indication for therapy.

Geriatric

Dependent on route of administration and indication for therapy.

Adolescents

Dependent on route of administration and indication for therapy.

Children

Dependent on route of administration and indication for therapy.

Infants

3 months and older: Dependent on route of administration and indication for therapy.
Less than 3 months: Safety and efficacy have not been established.

Desmopressin Acetate

injectable solution (DDAVP)

  • 4mcg/mL

tablet (DDAVP)

  • 0.1mg
  • 0.2mg

nasal spray (DDAVP, DDAVP Rhinal Tube)

  • 0.1mg/mL (5mL): Delivers 10mcg/spray

nasal spray (Stimate)

  • 1.5mg/mL (2.5mL): Delivers 150mcg/spray

preservative-free nasal spray (Noctiva)

  • 0.83 mcg of desmopressin acetate/0.1mL (equivalent to 0.75 mcg desmopressin)
  • 1.66 mcg of desmopressin acetate/0.1mL (equivalent to 1.5 mcg desmopressin)

tablet, sublingual (Nocdurna)

  • 27.7mcg of desmopressin acetate (equivalent to 25 mcg of desmopressin)
  • 55.3mcg of desmopressin acetate (equivalent to 50 mcg of desmopressin)
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