What are the uses and dosing guidelines for DDAVP (Desmopressin)?

DDAVP (Desmopressin) Uses and Dosing Guidelines

Desmopressin (DDAVP) is primarily indicated for central diabetes insipidus, hemophilia A with factor VIII levels >5%, and von Willebrand's disease Type I with factor VIII levels >5%, with standard dosing of 0.3 μg/kg for hemostatic purposes and 2-4 mcg daily for diabetes insipidus. 1

Primary Indications

Central Diabetes Insipidus

• Recommended as antidiuretic replacement therapy for central (cranial) diabetes insipidus 1
• Also indicated for temporary polyuria and polydipsia following head trauma or pituitary surgery 1
• Dosing: 2-4 mcg daily administered as one or two divided doses by subcutaneous or intravenous injection 1
• Dosage must be individually determined and adjusted according to patient response 1
• Not effective for nephrogenic diabetes insipidus 1

Hemophilia A

• Indicated for patients with factor VIII coagulant activity levels >5% 1
• Used to maintain hemostasis during surgical procedures and postoperatively 1
• Also used to reduce bleeding with spontaneous or traumatic injuries 1
• Dosing: 0.3 μg/kg (maximum 20 mcg) administered by intravenous infusion over 15-30 minutes 1
• Pretreatment testing required to verify factor VIII levels >5% and exclude factor VIII autoantibodies 1

Von Willebrand's Disease (Type I)

• Indicated for mild to moderate disease with factor VIII levels >5% 1
• Used to maintain hemostasis during surgical procedures or traumatic injuries 1
• Not indicated for severe Type I von Willebrand's disease or when abnormal molecular form of factor VIII antigen is present 1
• Dosing: 0.3 μg/kg (maximum 20 mcg) administered by intravenous infusion over 15-30 minutes 1
• For type 2B VWD, human-derived medium-purity FVIII concentrates complexed to Willebrand factor are preferred over DDAVP 2

Mechanism of Action

• Stimulates release of von Willebrand factor (vWF) from the endothelium 3
• Released vWF binds platelets to collagen through GP1b receptors and to other platelets through GPIIb/IIIa receptors 3
• Increases circulating levels of Factor VIII and von Willebrand's factor 4

Additional Clinical Applications

Antiplatelet Therapy Management

• May be considered in patients with platelet dysfunction secondary to cardiopulmonary bypass or recent antiplatelet therapy 3
• Suggested dose: 0.3 μg/kg diluted in 50 ml saline and infused over 30 minutes 3
• Limited efficacy with newer antiplatelet agents like ticagrelor and prasugrel 5
• May help manage bleeding in patients on antiplatelet therapy experiencing intracranial hemorrhage, though evidence for efficacy is uncertain 3, 5

Perioperative Use

• May lead to small reduction in blood loss and volume of RBCs transfused in cardiac surgery patients, though differences may not be clinically significant 3
• Prophylactic use in cardiac surgery has shown no benefit in multiple meta-analyses 5

Administration Guidelines

For Hemostatic Purposes

• Dilute in sterile 0.9% Sodium Chloride Injection, USP 1
• For patients ≤10 kg: dilute in 10 mL of saline 1
• For patients >10 kg: dilute in 50 mL of saline 1
• Infuse slowly over 15-30 minutes 1
• Monitor blood pressure and pulse during infusion 1
• May repeat doses after 8-12 hours and once daily thereafter if needed 1
• Tachyphylaxis may occur with repeated administration given more frequently than every 48 hours 1

Monitoring Requirements

• For diabetes insipidus: assess serum sodium, urine volume and osmolality before and during treatment 1
• For hemophilia A: verify factor VIII levels >5%, exclude factor VIII autoantibodies, and assess serum sodium and aPTT prior to treatment 1
• For von Willebrand's disease: assess serum sodium, bleeding time, factor VIII coagulant activity, ristocetin cofactor activity, and von Willebrand antigen 1
• For all patients receiving repeated doses: restrict free water intake and monitor for hyponatremia 1

Safety Considerations and Contraindications

Major Risks

• Hyponatremia is the primary adverse effect, which can be life-threatening if severe 1, 6, 7
• Contraindicated in patients with moderate to severe renal impairment (creatinine clearance <50 mL/min) 1
• Contraindicated in patients with hyponatremia or history of hyponatremia 1
• Not recommended for patients with excessive fluid intake, illnesses causing fluid/electrolyte imbalances, or those using loop diuretics or glucocorticoids 1
• May cause hypotension with compensatory tachycardia or hypertension 1
• Increased risk of thrombosis in patients with von Willebrand's disease Type IIB 1

Special Populations

• Elderly patients are at higher risk for hyponatremia and require more frequent monitoring 1, 6
• Not recommended in patients at risk for increased intracranial pressure or with history of urinary retention 1

Practical Considerations

• Platelet function testing may help identify patients who would benefit from DDAVP therapy 3, 5
• The initial response is reproducible if administered every 2-3 days 1
• For hemostatic purposes, DDAVP should be administered 30 minutes prior to procedures when used preoperatively 1