What is the proper dilution of Desmopressin (DDAVP)?

From the Guidelines

DDAVP (desmopressin) is typically administered orally in 0.2-mg tablets in doses of 0.2 to 0.6 mg nightly, or intranasally as a spray in doses of 10 to 40 μg (one to four sprays) nightly, with the lowest effective dose determined empirically for each child 1.

Administration and Dosage

When preparing dilutions for intravenous use, DDAVP injection (4 mcg/mL) can be administered directly or further diluted in normal saline or 5% dextrose solution to a volume of 50-100 mL for infusion.

• The standard dilution for IV administration is 0.5 mcg/kg in 50 mL of normal saline, infused over 15-30 minutes.
• For intranasal administration, DDAVP comes pre-diluted in commercial preparations at 100 mcg/mL or 10 mcg/0.1 mL.

Important Considerations

• DDAVP should be stored according to manufacturer recommendations, typically at room temperature (20-25°C) and protected from light.
• The dilution is necessary to achieve precise dosing, especially in pediatric patients or when administering smaller doses than what's available in pre-filled syringes.
• DDAVP works by increasing water reabsorption in the kidneys and raising levels of clotting factors VIII and von Willebrand factor, making proper dilution crucial for therapeutic efficacy and patient safety.

Safety and Efficacy

• Desmopressin is most efficient in children with nocturnal polyuria (nocturnal urine production greater than 130% of expected bladder capacity for age) and normal bladder reservoir function (maximum voided volume greater than 70% of expected bladder capacity for age) 1.
• Overall desmopressin is a safe drug with few side effects and low risks even when used for several years, but there is a single safety concern: if combined with an excessive fluid intake, desmopressin can cause water intoxication with hyponatremia and convulsions.
• A good rule of thumb for fluid intake is that an evening intake of 200 ml (6 ounces) or less and then no drinking until morning is well on the safe side 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Hemophilia A and von Willebrand’s Disease (Type I): Desmopressin acetate injection 4 mcg/mL is administered as an intravenous infusion at a dose of 0. 3 mcg desmopressin acetate/kg body weight diluted in sterile physiological saline and infused slowly over 15 to 30 minutes. In adults and children weighing more than 10 kg, 50 mL of diluent is recommended; in children weighing 10 kg or less, 10 mL of diluent is recommended.

The proper dilution of Desmopressin (DDAVP) is in sterile physiological saline. The recommended diluent volume is:

• 50 mL for adults and children weighing more than 10 kg
• 10 mL for children weighing 10 kg or less 2

From the Research

Desmopressin (DDAVP) Dilution

• The proper dilution of Desmopressin (DDAVP) is not explicitly stated in the provided studies, but various administration routes and dosages are mentioned 3, 4, 5, 6, 7.

Administration Routes and Dosages

• Intranasal administration: 2.5 µg to 10 µg once or twice daily 3, 10 µg twice daily 4.
• Oral administration: 100 µg tablet, with an average oral DDAVP dose required to obtain control of diuresis being 19 ± 2 (range: 15-30) times more than that of prior intranasal treatment 5.
• Intravenous administration: 0.25 to 2.0 µg/kg, using single or twice daily regimen 6.
• Subcutaneous injection: 0.4 µg/kg body weight, with a more concentrated preparation of 40 µg/ml 7.

Key Findings

• The studies suggest that the dosage and administration route of DDAVP may vary depending on the specific condition being treated, such as central diabetes insipidus, hemostatic disorders, or nocturnal enuresis 3, 4, 5, 6, 7.
• It is essential to carefully monitor patients for potential side effects, such as hyponatremia, when administering DDAVP 4, 6.