Tuesday, 19 April 2011

desmopressin



Generic Name: desmopressin (oral) (DEZ mo press in)

Brand Names: DDAVP


What is desmopressin?

Desmopressin is a man-made form of a hormone that occurs naturally in the pituitary gland. This hormone is important for many functions including blood flow, blood pressure, kidney function, and regulating how the body uses water.


Desmopressin is used to treat bed-wetting, central cranial diabetes insipidus, and increased thirst and urination caused by head surgery or head trauma.


Desmopressin may also be used for other purposes not listed in this medication guide.


What is the most important information I should know about oral desmopressin?


It is very important to reduce your intake of water and other fluids while you are taking desmopressin. Drinking too much water can cause your body to lose sodium, which may lead to a serious, life-threatening electrolyte imbalance.

Fluid restriction is especially important in children and older adults taking desmopressin. Follow your doctor's instructions about the type and amount of liquids you should drink.


You should not use this medication if you have severe kidney disease or if you have ever had hyponatremia (low sodium levels in your body).

Before taking desmopressin, tell your doctor if you have heart disease, coronary artery disease, congestive heart failure, kidney disease, cystic fibrosis, high or low blood pressure, an electrolyte imbalance, or a psychological disorder that causes extreme or unusual thirst.


To be sure desmopressin is helping your condition, your blood will need to be tested often. This will help your doctor determine how long to treat you with this medication. Do not miss any scheduled appointments.


What should I discuss with my healthcare provider before taking oral desmopressin?


You should not take this medication if you are allergic to desmopressin, or if you have:

  • severe kidney disease; or




  • if you have ever had hyponatremia (low sodium levels in your body).



Before taking desmopressin, tell your doctor if you are allergic to any medications, or if you have:



  • heart disease, coronary artery disease;




  • congestive heart failure;




  • kidney disease;




  • cystic fibrosis;




  • high or low blood pressure;




  • an electrolyte imbalance; or




  • a psychologic disorder that causes extreme or unusual thirst.



If you have any of these conditions, you may need a dose adjustment or special tests to safely take desmopressin.


FDA pregnancy category B. This medication is not expected to harm an unborn baby. Do not use desmopressin without telling your doctor if you are pregnant. It is not known whether desmopressin passes into breast milk, or if it could harm a nursing baby. Do not use desmopressin without telling your doctor if you are breast-feeding a baby.

How should I take desmopressin?


Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.


It is very important to reduce your intake of water and other fluids while you are taking desmopressin. Drinking too much water can cause your body to lose sodium, which may lead to a serious, life-threatening electrolyte imbalance.

Fluid restriction is especially important in children and older adults taking desmopressin. Follow your doctor's instructions about the type and amount of liquids you should drink.


If you are switching from desmopressin nasal spray to desmopressin tablets, wait at least 24 hours after your last nasal dose before you take your first tablet.

To be sure this medication is helping your condition, your blood will need to be tested often. This will help your doctor determine how long to treat you with desmopressin. Do not miss any scheduled appointments.


Store the tablets at room temperature away from moisture, light, and heat.

See also: Desmopressin dosage (in more detail)

What happens if I miss a dose?


Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.


What happens if I overdose?


Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include headache, confusion, drowsiness, rapid weight gain, or urination problems.


What should I avoid while taking desmopressin?


Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are taking desmopressin.


Desmopressin side effects


Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking desmopressin and call your doctor at once if you have any of these serious side effects:

  • nausea, vomiting, weakness, loss of appetite, headache, feeling restless or irritable, confusion, hallucinations, muscle pain or weakness, and/or seizure;




  • feeling like you might pass out;




  • swelling, weight gain; or




  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).



Less serious side effects may include:



  • headache;




  • nausea, mild stomach pain;




  • diarrhea; or




  • warmth, redness, or tingly feeling in your face.



This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.


Desmopressin Dosing Information


Usual Adult Dose for Diabetes Insipidus:

Initial dose: 0.05 mg orally twice a day or
1 to 2 mcg IV twice a day or
1 to 2 mcg subcutaneously twice a day or
5 to 40 mcg spray intranasally twice a day or
0.1 to 0.4 mL via rhinal tube intranasally twice a day.
The optimal dosage depends on the patient's response (duration of sleep and adequate, not excessive water turnover). The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover.

Usual Adult Dose for Hemophilia A:

IV: 0.3 mcg/kg once slowly over 15-30 minutes. Preoperative IV doses may be given 30 minutes prior to scheduled procedure. Blood pressure and heart rate monitoring during infusion is recommended. Repeat administration should be determined by laboratory response as well as the clinical condition of the patient.
Intranasal: 1 spray (1.5 mg/mL) in each nostril one time.
Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Preoperative doses may be given 2 hours prior to the scheduled procedure. Repeat administration should be determined by laboratory response and clinical condition of the patient.

Usual Adult Dose for von Willebrand's Disease:

IV: 0.3 mcg/kg once slowly over 15-30 minutes. Preoperative IV doses may be given 30 minutes prior to scheduled procedure. Blood pressure and heart rate monitoring during infusion is recommended. Repeat administration should be determined by laboratory response as well as the clinical condition of the patient.
Intranasal: 1 spray (1.5 mg/mL) in each nostril one time.
Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Preoperative doses may be given 2 hours prior to the scheduled procedure. Repeat administration should be determined by laboratory response and clinical condition of the patient. The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced.

Usual Adult Dose for Primary Nocturnal Enuresis:

Oral: 0.2 to 0.6 mg once before bedtime.

Usual Pediatric Dose for Diabetes Insipidus:

Infants 3 months of age to children 12 years of age:
Intranasal: 5 mcg/day as a single dose or in 2 divided doses. Dose range is 5 to 30 mcg/day. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover.
Oral: 0.05 mg twice a day. Dose range is 0.1 to 0.8 mg daily.
IV and subcutaneously: No definitive dosing available. Adult dosing should not be used in this age group; adverse events such as hyponatremia-induced seizures may occur. Dose should be reduced. Some have suggested an initial dosage range of 0.1 to 1 mcg in 1 or 2 divided doses. Initiate at low dose and increase as necessary. Closely monitor serum sodium levels and urine output; fluid restriction is recommended.

Children more than 12 years of age:
Intranasal: 5 to 40 mcg/day divided into 1 to 3 doses. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover.
Oral: 0.05 mg twice daily. Dose range is 0.1 to 1.2 mg divided into 2 or 3 doses.
IV: 1 to 2 mcg twice a day
Subcutaneously: 1 to 2 mcg twice a day

Use in children requires careful fluid intake restrictions to prevent possible hyponatremia and water intoxication. The optimal dosage depends on the patient's response (duration of sleep and adequate, not excessive water turnover).

Usual Pediatric Dose for Hemophilia A:

Infants 3 months of age and children:
IV: 0.3 mcg/kg by slow infusion over 15-30 minutes beginning 30 minutes before procedure. May repeat dose if needed.

Children more than 12 years of age:
IV: 0.3 mcg/kg once slowly over 15-30 minutes.
Intranasal:
50 kg or less: 150 mcg
more than 50 kg: 150 mcg in each nostril.
Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Preoperative doses may be given 2 hours prior to the scheduled procedure. Repeat administration should be determined by laboratory response and clinical condition of the patient.

Usual Pediatric Dose for von Willebrand's Disease:

Infants 3 months of age and children:
IV: 0.3 mcg/kg by slow infusion over 15 to 30 minutes beginning 30 minutes before procedure. May repeat dose if needed.

Children more than 12 years of age:
IV: 0.3 mcg/kg once slowly over 15 to 30 minutes.
Intranasal:
50 kg or less: 150 mcg
More than 50 kg: 150 mcg in each nostril.
Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Preoperative doses may be given 2 hours prior to the scheduled procedure. Repeat administration should be determined by laboratory response and clinical condition of the patient. The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced.

Usual Pediatric Dose for Primary Nocturnal Enuresis:

6 years or older:
0.2 to 0.6 mg orally once daily before bedtime.


What other drugs will affect desmopressin?


Many drugs can interact with desmopressin. Below is just a partial list. Tell your doctor if you are using:



  • carbamazepine (Carbatrol, Tegretol);




  • chlorpromazine (Thorazine);




  • lamotrigine (Lamictal);




  • oxybutynin (Ditropan, Urotrol, Oxytrol);




  • vasopressin (Pitressin);




  • a narcotic pain medicine such as fentanyl (Actiq, Duragesic), hydrocodone (Lortab, Vicodin), oxycodone (Oxycontin), and others;




  • an "SSRI" antidepressant such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft);




  • a tricyclic antidepressant such as amitriptyline (Elavil, Etrafon), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Janimine, Tofranil), and others;




  • medicine to treat erectile dysfunction, such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra);




  • drugs to treat high blood pressure or a prostate disorder, such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin), tamsulosin (Flomax);




  • a beta-blocker such as atenolol (Tenormin), bisoprolol (Zebeta, Ziac), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), or timolol (Blocadren); or




  • an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), etodolac (Lodine), indomethacin (Indocin), and others.



This list is not complete and there may be other drugs that can interact with desmopressin. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.



More desmopressin resources


  • Desmopressin Side Effects (in more detail)
  • Desmopressin Dosage
  • Desmopressin Use in Pregnancy & Breastfeeding
  • Drug Images
  • Desmopressin Drug Interactions
  • Desmopressin Support Group
  • 15 Reviews for Desmopressin - Add your own review/rating


  • desmopressin Nasal, Oral, Injection Advanced Consumer (Micromedex) - Includes Dosage Information

  • Desmopressin MedFacts Consumer Leaflet (Wolters Kluwer)

  • Desmopressin Prescribing Information (FDA)

  • DDAVP Prescribing Information (FDA)

  • Desmopressin Acetate Monograph (AHFS DI)

  • Minirin Spray MedFacts Consumer Leaflet (Wolters Kluwer)

  • Stimate Prescribing Information (FDA)

  • Stimate Spray MedFacts Consumer Leaflet (Wolters Kluwer)



Compare desmopressin with other medications


  • Diabetes Insipidus
  • Hemophilia A
  • Primary Nocturnal Enuresis
  • von Willebrand's Disease


Where can I get more information?


  • Your pharmacist can provide more information about desmopressin.

See also: desmopressin side effects (in more detail)


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