Cardiovascular: Acute cerebrovascular thrombosis, acute MI, blood pressure increased/decreased, chest pain, edema, facial flushing, palpitation

Central nervous system: Agitation, chills, coma, dizziness, headache, insomnia, somnolence

Endocrine & metabolic: Hyponatremia, water intoxication

Gastrointestinal: Abdominal cramps, dyspepsia, nausea, sore throat, vomiting

Genitourinary: Balanitis, vulval pain

Local: Injection: Burning pain, erythema, and swelling at the injection site

Respiratory: Cough, nasal congestion, epistaxis

Miscellaneous: Allergic reactions (rare), anaphylaxis (rare)

DDAVP®:

Tablet, nasal spray: Store at controlled room temperature of 20°C to 25°C (68°F to 77°F). Keep nasal spray in upright position.

Rhinal tube: Store refrigerated at 2°C to 8°C (36°F to 46°F). May store at room temperature for up to 3 weeks.

Injection: Store refrigerated at 2°C to 8°C (36°F to 46°F).

Stimate™: Store refrigerated at 2°C to 8°C (36°F to 46°F). May store at room temperature for up to 3 weeks.

Intranasal administration: Onset of increased factor VIII activity: 30 minutes (dose related)

Peak effect 1.5 hours

I.V. infusion:

Onset of increased factor VIII activity: 30 minutes (dose related)

Peak effect: 1.5-2 hours

Half-life elimination: Terminal: 75 minutes

Oral tablets:

Onset of action: ADH: ~1 hour

Peak effect: 4-7 hours

Half-life elimination: 1.5-2.5 hours

Bioavailability: 5% compared to intranasal; 0.16% compared to I.V.

Children:

Diabetes insipidus:

Intranasal (using 100 mcg/mL nasal solution): 3 months to 12 years: Initial: 5 mcg/day (0.05 mL/day) divided 1-2 times/day; range: 5-30 mcg/day (0.05-0.3 mL/day) divided 1-2 times/day; adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover; doses <10 mcg should be administered using the rhinal tube system

Oral: 4 years: Initial: 0.05 mg twice daily; total daily dose should be increased or decreased as needed to obtain adequate antidiuresis (range: 0.1-1.2 mg divided 2-3 times/day)

Hemophilia A and von Willebrand disease (type I):

I.V.: >3 months: 0.3 mcg/kg by slow infusion; may repeat dose if needed; begin 30 minutes before procedure

Intranasal: 11 months: Refer to adult dosing.

Nocturnal enuresis:

Intranasal (using 100 mcg/mL nasal solution): 6 years: Initial: 20 mcg (0.2 mL) at bedtime; range: 10-40 mcg; it is recommended that ¹/2 of the dose be given in each nostril

Oral: 0.2 mg at bedtime; dose may be titrated up to 0.6 mg to achieve desired response. Patients previously on intranasal therapy can begin oral tablets 24 hours after the last intranasal dose.

Children 12 years and Adults:

Diabetes insipidus:

I.V., SubQ: 2-4 mcg/day (0.5-1 mL) in 2 divided doses or ¹/10 of the maintenance intranasal dose

Intranasal (using 100 mcg/mL nasal solution): 10-40 mcg/day (0.1-0.4 mL) divided 1-3 times/day; adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. Note: The nasal spray pump can only deliver doses of 10 mcg (0.1 mL) or multiples of 10 mcg (0.1 mL); if doses other than this are needed, the rhinal tube delivery system is preferred.

Oral: Initial: 0.05 mg twice daily; total daily dose should be increased or decreased as needed to obtain adequate antidiuresis (range: 0.1-1.2 mg divided 2-3 times/day)

Hemophilia A and mild to moderate von Willebrand disease (type I):

I.V.: 0.3 mcg/kg by slow infusion, begin 30 minutes before procedure

Intranasal: Using high concentration spray (1.5 mg/mL): <50 kg: 150 mcg (1 spray); >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

I.V.: Dilute in 0.9% sodium chloride and infuse over 15-30 minutes; dose should be diluted in 10 mL NS for children 10 kg; 50 mL NS for adults and children >10 kg

Intranasal: DDAVP®: Nasal pump spray delivers 0.1 mL (10 mcg); for other doses which are not multiples, use rhinal tube. DDAVP® Nasal spray delivers fifty 10 mcg doses. Any solution remaining after 50 doses should be discarded. Pump must be primed prior to first use.

Diabetes insipidus: Fluid intake, urine volume, specific gravity, plasma and urine osmolality, serum electrolytes

Hemophilia: Factor VIII antigen levels, aPTT, bleeding time (for von Willebrand disease and thrombocytopathies)

Diabetes insipidus: Avoid overhydration. Weigh yourself daily at the same time in the same clothes. Report increased weight or swelling of extremities. If using intranasal product, inspect nasal membranes regularly. Report swelling or increased nasal congestion.

All uses: Report unresolved headache, respiratory difficulty, acute heartburn or nausea, abdominal cramping, or vulval pain. Breast-feeding precaution: Consult prescriber if breast-feeding.

Injection, solution, as acetate (DDAVP®): 4 mcg/mL (1 mL, 10 mL)

Solution, intranasal, as acetate (DDAVP®): 100 mcg/mL (2.5 mL) [with rhinal tube]

Solution, intranasal spray, as acetate: 100 mcg/mL (5 mL) [delivers 10 mcg/spray]

DDAVP®: 100 mcg/mL (5 mL) [delivers 10 mcg/spray]

Stimate™: 1.5 mg/mL (2.5 mL) [delivers 150 mcg/spray]

Tablet, as acetate (DDAVP®): 0.1 mg, 0.2 mg

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Cattaneo M, "Review of Clinical Experience of Desmopressin in Patients With Congenital and Acquired Bleeding Disorder,"Eur J Anesthesiol Suppl, 1997, 14:10-4.

Chistolini A, Dragoni F, Ferrari A, et al, "Intranasal DDAVP®: Biological and Clinical Evaluation in Mild Factor VIII Deficiency,"Haemostasis, 1991, 21(5):273-7.

Lindeman RD, Lee TD Jr, Yiengst MJ, et al, "Influence of Age, Renal Disease, Hypertension, Diuretics, and Calcium on the Antidiuretic Responses to Suboptimal Infusions of Vasopressin,"J Lab Clin Med, 1966, 68(2):206-23.

Lusher JM, "Response to 1-Deamino-8-D-Arginine Vasopressin in von Willebrand Disease,"Haemostasis, 1994, 24(5):276-84.

Mannucci PM and Cattaneo M, "Desmopressin: A Nontransfusional Treatment of Hemophilia and von Willebrand Disease,"Haemostasis, 1992, 22(5)276-80.

Miller JH and Shock NW, "Age Differences in the Renal Tubular Response to Antidiuretic Hormone,"J Gerontol, 1953, 8:446-50.

Richardson DW and Robinson AG, "Desmopressin,"Ann Intern Med, 1985, 103(2):228-39.

Stenberg A and L&auml;ckgren G, "Desmopressin Tablets in the Treatment of Severe Nocturnal Enuresis in Adolescents,"Pediatrics, 1994, 94(6 Pt 1):841-46.