ADMINISTRATION ROUTES:
IV, IM, SC, Intranasal
ALTERNATIVE NAMES:
Minirin, Octostim
ICU INDICATIONS:
- Treatment of central diabetes insipidus
- Prevention and control of bleeding (primarily when there are thought to be platelet function defects especially uraemia, clopidogrel or cardiopulmonary bypass-related)
PRESENTATION AND ADMINISTRATION:
IV:
Minirin 4 mcg/mL injection
Octostim 15 mcg/mL injection
Doses of 4 mcg or less should be administered undiluted by direct IV injection. For small doses (e.g 0.4 mcg), 4 mcg can be diluted in 10 mL of Normal saline.
For doses of greater than 4 mcg in adults or children weighing more than 10 kg, dilute with 50 mL of Normal saline and infuse the first 5 mL slowly over 5 minutes. For children weighing less than 10 kg, dilute in 10 mL of Normal saline and infuse the first 1-2 mL over 5 minutes. If no marked tachycardia or other adverse effects are observed, give the remainder slowly over 15 minutes.
PO:
Minirin 0.1mg tablets (white)
Nasal Spray:
Desmopressin spray (10 mcg/dose), Minirin spray (10 mcg/dose), Octostim (150 mcg/dose)
DOSAGE:*
IV (preferred route):
Central diabetes insipidus:
0.4 mcg repeated as required
May increase the dose if there is inadequate response
Prevention and control of bleeding:
0.3 mcg/kg (max 24 mcg) given over 30 minutes, once only
PO:
0.1 - 1.2 mg OD depending on indication
Rarely used by this route in ICU
Nasal Spray:
Not generally administered by this route in ICU
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
Prevention and control of bleeding:
over 3 months old: 0.3 mcg/kg OD
CLINICAL PHARMACOLOGY:
Desmopressin is a synthetic analogue of the natural pituitary hormone arginine vasopressin (ADH), an antidiuretic hormone affecting renal water conservation.
CONTRAINDICATIONS:
- Hypersensitivity to desmopressin
- Hyponatraemia
WARNINGS:
When desmopressin acetate injection is administered to patients who do not have need of antidiuretic hormone for its antidiuretic effect, in particular in paediatric and geriatric patients, fluid intake should be adjusted downward to decrease the potential occurrence of water intoxication and hyponatraemia.
Particular attention should be paid to the possibility of the rare occurrence of an extreme decrease in plasma osmolality that may result in seizures which could lead to coma.
PRECAUTIONS:
General:
Desmopressin acetate injection has infrequently produced changes in blood pressure causing either a slight elevation in blood pressure or a transient fall in blood pressure and a compensatory increase in heart rate. The drug should be used with caution in patients with coronary artery insufficiency and/or hypertensive cardiovascular disease. There have been rare reports of thrombotic events following desmopressin acetate Severe allergic reactions have been reported rarely. Anaphylaxis has been reported rarely with desmopressin.
Laboratory Tests:
Regular electrolyte monitoring. Urine & plasma osmolality may be required
Drug/Laboratory Test Interactions:
None of note
IMPORTANT DRUG INTERACTIONS IN ICU:
DDAVP may cause minor increases in blood pressure requiring changes in levels of vasopressor support.
ADVERSE REACTIONS:
Central Nervous System:
Transient headache, ischaemic stroke
Cardiovascular System:
Changes in blood pressure causing either a slight elevation or a transient fall and a compensatory increase in heart rate, myocardial infarction
Gastrointestinal System:
Nausea, mild abdominal cramps
Metabolic and Endocrine System:
Water intoxication and hyponatraemia
Skin:
Local irritation at site of injection