DDAVP

DESMOPRESSIN:

  • vasopressin analogue
    • does not have vasoconstriction / antidiuretic effects of vasopressin
  • DDAVP = deamino-arginine vasopressin

 

Mechanism of Action:

  • Increases cAMP in renal tubular cells –> increases water permeability –> decreased urine volume
  • Increases plasma vWF, F8 and t-PA –> shortened aPTT and bleeding time

 

DOSAGE:

1. Uremic bleeding (off-label): 0.4 mcg/kg IV over 10 minutes

  • corrects bleeding time in 75% of patients with renal failure
  • renal failure with significant bleeding: 1 dose given empirically; 2nd dose 8-12h later
  • recommended dose: 0.3 ug/kg IV, SQ or 30 ug/Kg intranasally
  • effect lasts 6-8h, repeated dosing leads to tachyphylaxis; responsiveness restored if drug withheld x 3-4d

2. Prevention of surgical bleeding in uremia (off-label): 0.3 mcg/kg IV over 30 minutes

3. Diabetes insipidus:

  • IV, SubQ: 2 to 4 mcg daily (0.5-1 mL) in 2 DD or 1/10 of maintenance intranasal dose
  • Oral: 0.05 mg BID, titrate total daily dose to adequate antidiuresis (0.1 to 1.2 mg in 2-3 DD)
  • Intranasal (100 mcg/mL nasal solution): 10-40 mcg OD (0.1 to 0.4 mL) or in 2-3 DD

4. Hemophilia A and von Willebrand disease (type 1):

  • IV: 0.3 mcg/kg by slow infusion; may repeat dose if needed; if used preoperatively, administer 30 minutes before procedure
  • Intranasal (using high concentration spray [1.5 mg/mL] [eg, Stimate]): <50 kg: 150 mcg (1 spray in a single nostril); ≥50 kg: 300 mcg (1 spray each nostril); repeat use is determined by the patient’s clinical condition and laboratory work. If using preoperatively, administer 2 hours before surgery.

 

5. Reversal of Aspirin in ICH:  0.4 ug/Kg x 1 dose

Capture

 

 

References

Marino, Paul L, and Kenneth M Sutin. The ICU Book. Philadelphia: Lippincott Williams & Wilkins, 2007. Print.

Uptodate.

 

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