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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)