From the FDA Drug Label
The recommended starting daily dosage is 2 mcg to 4 mcg administered as one or two divided doses by subcutaneous or intravenous injection. Patients changing from intranasal desmopressin: The recommended starting dose of desmopressin acetate injection is 1/10th the daily maintenance intranasal dose administered by subcutaneous or intravenous injection as one or two divided doses
The maximum subcutaneous dose of Desmopressin (DDAVP) is not explicitly stated in the drug label for the treatment of Diabetes Insipidus. However, for Hemophilia A and von Willebrand's Disease (Type I), the maximum dose is 20 mcg administered by intravenous infusion, but this does not apply to subcutaneous administration. Since the label does not provide a clear maximum dose for subcutaneous administration, no conclusion can be drawn regarding the maximum subcutaneous dose of Desmopressin (DDAVP) 1.
From the Research
The maximum subcutaneous dose of DDAVP (desmopressin acetate) is 0.4 micrograms/kg body weight, as supported by the study published in 1989 2. DDAVP is a synthetic analog of vasopressin used to treat conditions like central diabetes insipidus, nocturnal enuresis, and certain bleeding disorders. When administered subcutaneously, the onset of action is typically within 15-30 minutes, with a duration of action of 8-12 hours. Patients should be monitored for potential side effects including hyponatremia (low sodium levels), which can occur due to the antidiuretic effect of the medication. Fluid intake should be restricted during DDAVP therapy to reduce the risk of water intoxication. Dose adjustments may be necessary based on individual patient response, kidney function, and age, with lower doses often recommended for elderly patients. The subcutaneous route provides more reliable absorption compared to intranasal administration and is particularly useful when precise dosing is required.
Some key points to consider when administering DDAVP subcutaneously include:
- The dose of 0.4 micrograms/kg body weight is supported by a study published in 1989 2, which found that this dose produced a 2.5-fold increase in factor VIII:C and a 1.9-fold increase in von Willebrand factor:Ag.
- Another study published in 1984 3 also found that subcutaneous administration of DDAVP was effective in increasing factor VIII:C levels in patients with hemophilia A and von Willebrand's disease.
- However, the quality of evidence for the use of DDAVP in minimizing perioperative blood transfusion is very low to moderate, as reported in a 2017 Cochrane review 4.
- It is essential to monitor patients for potential side effects and adjust the dose as needed to minimize the risk of adverse effects.
Overall, the subcutaneous administration of DDAVP can be an effective and reliable treatment option for patients with certain bleeding disorders, but it is crucial to carefully consider the dose and potential side effects to ensure optimal outcomes.