Desmopressin

CLINICAL USE

Diabetes insipidus Nocturnal enuresis Post-biopsy bleeding (unlicensed indication)Pre-biopsy prophylaxis (unlicensed indication)

DOSE IN NORMAL RENAL FUNCTION

Diabetes insipidus: Oral: 0.2–1.2 mg daily in 3 divided doses. IV: 1–4 mcg daily. Inhaled: 10–40 mcg in 1 or 2 divided doses. Sub-lingual: 120–720 mcg dailyNocturnal enuresis: Oral: 200–400 mcg at bedtime, Biopsy: Males – 16 mcg; Females – 12 mcg or 300–400 nanograms/kg Pre-biopsy prophylaxis in uraemic patients: 20 mcg (IV) over 30 minutes

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :1069.2

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :0

%Excreted unchanged in urine &nbsp &nbsp : 45

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.2–0.41

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :Inhaled: 55 minutes; Oral: 2.8 hours; IV: 51–158 minutes/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in normal renal function

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Unlikely to be dialysed. Dose as in normal renal function

HDF/high flux &nbsp :Unknown dialysability. Dose as in normal renal function

CAV/VVHD &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsNone known

ADMINISTRATION

Reconstition

Dilute dose to 50 mL with sodium chloride 0.9%

Route

IV, intranasally, oral, SC, IM, SL

Rate of Administration

Over 20–60 minutes

Comments

Do not inject at a faster rate – greater risk of tachyphylaxisIn patients with ischaemic heart disease, infuse more slowly – increased risk of acute ischaemic event

OTHER INFORMATION

Emergency treatment of more generalised bleeding unresponsive to normal treatments: 0.1–0.5 micrograms/kg 4 times a day + IV conjugated oestrogens (premarin) 0.6 mg/kg/day for up to 5 days DDAVP works as a haemostatic by stimulating factor VIII production Onset of action less than 1 hour. Duration of effect 4–8 hours

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