What is the dosing of nasal desmopressin (DDAVP) for the treatment of nosebleed?

Nasal Desmopressin Dosing for Nosebleed

For nosebleeds, desmopressin should be administered at a dose of 0.3 μg/kg diluted in 50 ml saline and infused over 30 minutes. 1

Indications and Mechanism of Action

• Desmopressin (DDAVP; 1-deamino-8-D-arginine vasopressin) enhances platelet adherence and platelet aggregate growth on human artery subendothelium 1
• It is primarily indicated for patients with nosebleeds who are:
  • Taking platelet-inhibiting drugs (aspirin, clopidogrel, etc.) 1
  • Diagnosed with von Willebrand disease 1
• Desmopressin has been specifically recommended for patients taking platelet inhibitors who are suffering from bleeding, including intracerebral hemorrhage 1

Dosing Protocol

• The standard intravenous dose is 0.3 μg/kg diluted in 50 ml saline and infused over 30 minutes 1
• For intranasal administration (spray form), the typical dose is 150 μg to each nostril (300 μg total) 2, 3
• High-concentration intranasal desmopressin (1.5 mg/mL) at a dose of 150 μg has been shown effective in patients weighing ≤50 kg 4

Patient Selection

• Desmopressin is not recommended for routine use in all bleeding patients 1
• Patients most likely to benefit include:
  • Those with impaired platelet function as assessed by platelet function analyzer (PFA-100) or whole blood multiple electrode aggregometer 1
  • Patients taking platelet inhibitors (aspirin, clopidogrel) 1
  • Patients with von Willebrand disease 1, 5

Clinical Efficacy

• Desmopressin has been shown to improve platelet function in volunteers on aspirin and clopidogrel 1
• It has demonstrated efficacy in patients with mild inherited platelet defects in perioperative settings 1
• The combined effect of platelet concentrates followed by desmopressin administration has been advocated to enhance recovery of normal platelet function 1

Important Caveats and Limitations

• Desmopressin has never been formally investigated specifically for nosebleeds or in general trauma or traumatic brain injury 1
• The use of desmopressin for acquired bleeding disorders is not supported by robust clinical evidence 1
• Potential adverse effects include:
  • Water retention with consecutive hyponatremia 1
  • Convulsions may occur following repeated injections 1
  • Particular caution is needed in elderly patients 1
• For severe nosebleeds, consider additional measures as outlined in clinical practice guidelines:
  • Local measures to control bleeding 1
  • Appropriate reversal agents if patient is on anticoagulants 1
  • Nasal endoscopy to identify the bleeding site 1

Alternative Approaches

• For nosebleeds without coagulopathy, consider:
  • Topical vasoconstrictors (oxymetazoline, phenylephrine) 1
  • Nasal cautery for identified bleeding sites 1
  • Moisturizing or lubricating agents after bleeding is controlled 1
• For patients on antiplatelet therapy with severe bleeding, platelet transfusion may be considered, though evidence for benefit is limited 1