Parenteral Manual

Desmopressin acetate

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
DDAVP, OCTOSTIM
Classification: 
Antidiuretic hormone analogue
Original Date: 
August 2005
Revised Date: 
November 2011
Indications: 
  • Maintenance of hemostasis in patients with hemophilia A during and after surgical procedures or spontaneous trauma
  • May be used for patients with mild - moderate type 1 von Willebrand disease
  • Antidiuretic hormone replacement therapy for central diabetes insipidus
Reconstitution and Stability: 
  • Available as 4 mcg/mL and 15 mcg/mL solution
  • Refrigerate, DO NOT freeze
  • Protect from light
  • Diluted solutions in NS or D5W are stable for 24 hours at room temperature
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: no information

- Incompatible: no information

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES, preferred for diabetes insipidus -slowly over 10 - 20 seconds
IM YES, preferred for diabetes insipidus
IV Direct YES, diabetes insipidus only. Critical care areas only
IV Intermittent Infusion YES
Usual dilution: 0.1 microgram/mL
Infusion time: 15-30 minutes
IV Continuous Infusion

YES
Usual dilution: 0.1 mcg/mL

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Diabetes Insipidus:

  • < 12 years: No definitive dosing available.  Some studies have used 0.1 to 1 mcg IV/SC in 1 or 2 divided doses.  Initiate at low dose and increase as necessary
  • > = 12 years and adult:  2-4 mcg/day IV/SC divided BID or 1/10 of the maintenance intranasal dose

- Hemophilia A, von Willebrand's disease Type I:

  • 0.3 mcg/kg (Maximum: 20 mcg/dose) beginning 30 minutes before procedure
  • May repeat dose after > 12 hours if necessary
Potential hazards of parenteral administration: 
  • Facial flushing, headache, abdominal cramps
  • Hypertension or hypotension, tachycardia, palpitations
  • ** Decreased urine output for 6-8 hours, hyponatremia (CAUTION: water intoxication may occur - regulate fluid intake carefully; monitor serum sodium, urine output and osmolarity)
  • Vein irritation (local burning or pain)
Notes: 
  • Contraindicated in patients with severe hemophilia A with factor VIII antibodies, hemophilia B,  severe Type I von Willebrand, Type II B von Willebrand, or platelet-type (pseudo) von Willebrand disease
  • Use with caution in patients with predisposition to thrombus formation, conditions associated with fluid and electrolyte imbalance and in patients with coronary artery disease and/or hypertensive cardiovascular disease
  • Desmopressin can increase fibrinolysis, due to plasminogen activator release; concurrent use of aminocaproic acid or tranexamic acid is recommended for patients with clotting disorders
  • For patients stabilized on intranasal therapy, the parenteral/subcutaneous dose is approximately 1/10 of the intranasal dose
  • Dosage equivalency when changing routes of administration: 1 mcg IV/SC/IM = 10 mcg intranasal = 100-200 mcg oral
  • Peak effect on blood clotting occurs within 1 hour of IV dose

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