DDAVP Nasal

Brand Name(s) DDAVP, DDAVP Nasal, DDAVP Rhinal Tube, Minirin, Stimate Chemical Class Arginine vasopressin analog... 

NflSfllSpray 0.01 mg/inhalation (DDAVP Nasal), 0.15 mg/inhalation (Stimate). Indications and Dosages ... 

Primary therapy is based on disease severity and type of hemorrhage.7 Most patients with mild to moderate disease and a minor bleeding episode can be treated with l-desamino-8-D-arginine vasopressin [desmopressin acetate (DDAVP)], a synthetic analog of the antidiuretic hormone vasopressin. DDAVP causes release of von Willebrand factor (vWF) and factor VIII from endogenous storage sites. This formulation increases plasma factor VIII levels by three- to fivefold within 30 minutes. The recommended dose is 0.3 mcg/kg intravenously (in 50 mL normal saline infused over 15 to 30 minutes) or subcutaneously or 300 meg intranasally via concentrated nasal spray every 12 hours. Peak effect with intranasal administration occurs 60 to 90 minutes after administration, which is somewhat later than with intravenous administration. Desmopressin infusion may be administered daily for up to 2 to 3 days. Tachyphylaxis, an attenuated response with repeated administration, may occur after several doses.8... 

ADH itself is available for injections (Pitressin) but has a half-life of about 15 minutes. Desmopressin (DDAVP) is an analogue without an amino group at the first amino acid and with o-arginine instead of l-arginine. This analogue is more stable and has very little pressor activity. Desmopressin can be given subcutaneously or nasally, and the effects last for 12 hours. 

Enuresis 10-40 ag qhs/bid Headache nausea Hyponatremia and water intoxication at toxic doses Can be useful for acute situations (e.g., sleepaways) or as maintenance treatment DDAVP 0.1, 0.2 mg t nasal spray 10 Hg/ spray... 

Only two antidiuretic peptides are available for clinical use in the United States (1) Vasopressin (synthetic 8-l-arginine vasopressin Pitressin) is available as a sterile aqueous solution it may be administered subcutaneously, intramuscularly, or intranasally. (2) Desmopressin acetate (synthetic l-deamino-8-D-arginine vasopressin DDAVP, others) is available as a sterile aqueous solution packaged for intravenous or subcutaneous injection, in a nasal solution for intranasal administration with either a nasal spray pump or rhinal tube delivery system, and in tablets for oral administration. The therapeutic uses of vasopressin and its congeners can be divided into two main categories according to the type of vasopressin receptor involved. 

Desmopressin, as its acetate salt, is a synthetic analogue of vasopressin in which the N-terminal Cys is devoid of its a-amino function (1-Deamino) and where Arg is present as its D-isomer (D-Arg ), thus the commercial acronym DDAVP (Fig. 7.15). The presence of D-Arg and the absence of the N-terminal amine in the desmopressin structure have increased its half-life such that it is available for oral, parenteral, or nasal use. It is used by all three of these routes of administration to prevent or control polydipsia (excessive thirst), polyuria, and dehydration of patients with diabetes insipidus caused by a deficiency of vasopressin. It also has been approved for the treatment of nocturnal enuresis (bed-wetting), which is believed to be caused by an absence of the normal night time rise in vasopressin levels. 

DDAVP is given intranasally, and the nurse should be alert to symptoms of rhinitis, but lack of nasal drainage does not indicate that the medication is effective. 

Desmopressin acetate (DDAVP)— watch for weight gain, headache, restless, and signs of hyponatremia and water intoxication as signs of excessive treatment and polyuria with low specific gravity for inadequate dosage. Chronic treatment could result in nasal irritation. 

---