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. The FDA drug label does not answer the question.
From the Research
DDAVP (desmopressin) clamp dosing for diagnostic or therapeutic purposes is typically 0.3 mcg/kg intravenously, diluted in normal saline and administered over 15-30 minutes, as supported by studies such as 1 and 2.
Key Considerations
- The dose of 0.3 mcg/kg is recommended to minimize side effects such as facial flushing, transient headache, increased pulse rate, and drop in systolic blood pressure, as noted in 1.
- For adults, this often translates to a standard dose of 20-24 mcg.
- The DDAVP clamp is used to assess von Willebrand factor (vWF) and Factor VIII responses, particularly in diagnosing von Willebrand disease or monitoring treatment response.
Administration and Monitoring
- Blood samples are typically collected at baseline and at intervals (30 minutes, 1 hour, 2 hours, and 4 hours) after administration to measure the rise in vWF and Factor VIII levels.
- Patients should be monitored for potential side effects including headache, facial flushing, mild hypotension, and hyponatremia, as mentioned in 2.
- Fluid restriction is often recommended during and for 24 hours after the test to prevent water retention and hyponatremia.
Special Considerations
- The test should be used cautiously in elderly patients and those with cardiovascular disease, and is contraindicated in patients with type IIB von Willebrand disease as it may paradoxically worsen platelet aggregation.
- Although studies such as 3, 4, and 5 discuss the use of desmopressin in various contexts, the most relevant and recent evidence for DDAVP clamp dosing is found in earlier studies like 1 and 2.