DESMOPRESSIN

ADMINISTRATION  ROUTES: IV,  IM,  SC,  Intranasal DDAVP/Desmopressin

INDICATIONS: 

1. Treatment  of  central  diabetes  insipidus 2. 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  4mcg/ml  injection Octostim  15mcg/ml  injection Doses  of  4mcg  or  less  should  be  administered  undiluted  by  direct  IV  injection.    For small  doses  (eg  0.4mcg),  4mcg  can  be  diluted  in  10  ml  of  normal  saline. For  doses  of  greater  than  4mcg  in  adults  or  children  weighing  more  than  10kg,  dilute with  50ml  of  normal  saline  and  infuse  the  first  5ml  slowly  over  5  minutes.    For  children weighing  less  than  10kg,  dilute  in  10ml  of  normal  saline  and  infuse  the  first  1-2ml  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  (10mcg/dose),  Minirin  spray  (10mcg/dose),  Octostim  (150mcg/ dose) 

DOSAGE: 

IV: Central  diabetes  insipidus: 0.4mcg  repeated  as  required  (may  increase  the  dose  if  there  is  an  adequate  response)

 Prevention  and  control  of  bleeding: 0.3mcg/kg  (max  24mcg)  over  30  minutes  (once  only) Note:  although  IM  and  SC  routes  can  be  used,  IV  is  generally  the  preferred  route. PO: 0.1mg  -1.2mg  daily  depending  on  indication  (rarely  used  by  this  route  in  ICU)

 Nasal  Spray: Not  generally  administered  by  this  route  in  ICU

No adjustments needed in CRF

CLINICAL  PHARMACOLOGY: Desmopressin  is  a  synthetic  analogue  of  the  natural  pituitary  hormone  arginine vasopressin  (ADH),  an  antidiuretic  hormone  affecting  renal  water  conservation..

 CONTRAINDICATIONS: 

1. Hypersensitivity  to  desmopressin 2. 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. 

Laboratory  Tests:

 Laboratory  tests  for  monitoring  the  patient  include  urine  volume  and  osmolality.  In  some cases,  plasma  osmolality  may  be  required.

NB: may  cause  minor  increases  in  blood  pressure  requiring  changes  in  levels  of vasopressor  support. 

ADVERSE  REACTIONS 

 transient  headache,  ischaemic  stroke,  changes  in  blood  pressure  causing  either  a  slight  elevation  or  a  transient  fall  and  a compensatory  increase  in  heart  rate,  myocardial  infarction, nausea, abdominal cramps, water  intoxication  and  hyponatraemia,Local  irritation  at  site  of  injection,  thrombotic  events