Desmopressin - Intensive Care & Coordination Monitoring Unit

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Liverpool Health Service Drug Administration Protocol First Issued February 2002 Intensive Care Unit Contraindications Type IIB von Willebrand's disease. Habitual and psychogenic polydipsia. Cardiac insufficiency and other conditions requiring treatment with diuretic agents. Hypersensitivity to the preservative. Desmopressin is ineffective for the treatment of nephrogenic diabetes insipidus. Precautions Overhydration, especially with children, the elderly, when used with concurrent fluid replacement. Patients with a history of cardiac failure and when used to test renal concentrating ability. Excessive water intake or chronic use of desmopressin can produce hyponatraemia with associated effects. When desmopressin is used for diagnostic purposes, the fluid intake must be limited and not exceed 0.5 litres from one hour before until eight hours after administration. Desmopressin should not be administered to dehydrated or overhydrated patients until water balance has been adequately restored. In haemophilia, where high doses are given, extreme care must be paid to the water balance. Fluid intake should be restricted as much as possible and the patient should be weighed regularly. Not for intransal administration if rhinorrhoea or local infection exists. Use with caution in patients with cystic fibrosis because of impaired water handling and increased risk of hyponatraemia. Use with caution in patients at risk of increased intracranial pressure secondary to fluid retention. Significant Interactions Tricyclic antidepressants, chlorpromazine and carbamazepine may cause an additive antidiuretic effect and increase the risk of water retention. Indomethacin may augment the magnitude but not the duration of the response to desmopressin. Glibenclamide inhibits the antidiuretic effect of desmopressin. Clofibrate has potentiated and prolonged the effects of desmopressin. Adverse Effects Tachycardia, fall in diastolic blood pressure by 10 to 20% with large IV doses. Hypertension. Headache, nausea, mild abdominal cramp, vomiting. Nasal congestion, facial flushing, vulval pain. Water intoxication from overhydration, hyponatraemia. Presentation Intranasal solution, 100 micrograms/mL, 2.5mL dropper bottle plus rhinyle (Minirin). Injection, 4 micrograms/mL in 1mL ampoule (DDAVP). Injection, 15 micrograms/mL in 1mL ampoule (Octostim) for intravenous use only. Reviewed: September 2004 Authors: M. Edgtton-Winn Page 2 of 2 Review Date: September 2005
Liverpool Health Service Drug Administration Protocol First Issued February 2002 Intensive Care Unit Administration Guidelines ADH sensitive cranial diabetes insipidus: Adults. Intranasally 5 to 20 micrograms twice daily, adjusted for adequate sleep patterns. IV, IM or SC slow injection, undiluted using a diabetic syringe. Administer 0.5 – 1.0 microgram which may require bd or tds dosage. Dosage is controlled by measurement of serum and urine osmolality. A single daily dose may be used if tolerated and provides control of the diabetes insipidus. Paediatric. Intranasally 1.25 to 10 micrograms twice daily. IV, IM or SC up to 200 nanograms twice daily as a slow, injection using a diabetic syringe. A single daily dose may be used if tolerated and provides control of the diabetes insipidus. Notes: Intranasal administration: ⇒ Load the dose from the dropper bottle into the plastic catheter following manufacturer's instructions. ⇒ The patient places one end of the catheter into the mouth, and the other end into a nostril, and the contents of the catheter are blown into the nasal cavity. The dose is not inhaled! Parenteral administration: ⇒ When using doses less than 4 micrograms the dose should be drawn up from the ampoule as a fraction of a ml using a diabetic syringe without dilution or use of infusion. Diagnostic test of renal concentrating capacity: Intranasal. Adults. Single dose of up to 40 micrograms. Children. Single dose of up to 20 micrograms. Intramuscular. Adults. Single dose of up to 4 micrograms. Mild/moderate haemophilia A and von Willebrand's disease. Parenteral administration only. VIII:C assays should be undertaken regularly during treatment. When surgery or dental extractions are to be undertaken, tranexamic acid should be given intravenously (tranexamic acid 10 mg/kg) unless contraindicated, then 25 mg/kg orally three to four times daily until healing is complete. Within 1/2 hour before surgery desmopressin 0.4 microgram/kg diluted to 10 to 100 ml in normal saline is given as a slow intravenous infusion over 15 to 20 minutes before and 20 minutes after the infusion. VIII:C assays and in the case of von Willebrand's disease determination of VIIIR:Ag and bleeding time should also be carried out. If a sufficient response was obtained with the initial dose of desmopressin, further doses may be given at 12 hourly intervals so long as cover is required. VIII:C levels must be monitored regularly since some patients have shown a diminishing response to successive infusions. If a sufficient level has not been reached to cover the intended surgical procedure, a supplementary dose of factor VIII concentrate should be given to make up the deficit. Treatment of bleeding in patients with inherited and acquired platelet function defects: Desmopressin is given at a dose of 0.3 microgram/kg diluted to 50 mL sterile 0.9% normal saline as a slow intravenous infusion over 30 minutes. Further doses may be given at 12 hourly intervals as long as cover is required. In some patients a 12 hourly injection for three to four days may result in clinically significant fluid retention. General surgery (except cardiac surgery): Half an hour prior to surgery, desmopressin is given as a slow intravenous infusion over 30 minutes. Cardiac surgery: Desmopressin is administered in patients with a prolonged bleeding time when bypass has been completed and immediately after protamine has been given to neutralize the effect of heparin or at any time thereafter. Nonsurgical use: In patients with epistaxis, menorrhagia or other bleeding episodes, desmopressin is given as a slow intravenous infusion over 30 minutes. Red blood cell transfusion is of value in improving haemostasis in uraemic patients. Reviewed: September 2004 Authors: M. Edgtton-Winn Page 3 of 3 Review Date: September 2005
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Desmopressin - Intensive Care & Coordination Monitoring Unit

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