Desmopressin acetate

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... 

Administration of an AVP analog, such as desmopressin acetate (DDAVP), can produce a 30% to 60% reduction in wet nights in general, and about a 50% resolution of enuresis while on the medication (Norgaard et ah, 1985 Klauber, 1989 Norgaard et al.. 

Antidiuretic hormone analogs desmopressin acetate vasopressin... 

Desmopressin Acetate (DDAVP) Chemically synthesized analogue of arginine vasopressin Treatment of diabetes insipidus... 

Desmopressin acetate increases the factor VIII activity of patients with mild hemophilia A or von Willebrand disease. It can be used in preparation for minor surgery such as tooth extraction without any requirement for infusion of clotting factors if the patient has a documented adequate response. High-dose intranasal desmopressin (see Chapter 17) is available and has been shown to be efficacious and well tolerated by patients. 

Desmopressin acetate is a synthetic analogue of the natural pituitary hormone 8-arginine vasopressin, an antidiuretic hormone affecting renal water conservation. It contains 1.5 mg/mL desmopressin acetate in a pH-adjusted aqueous solution with hydrochloric acid to 4.0 ... 

Salzman EW, Weinstein MJ, Weintraub RM, Ware JA, Thurer RL, Robertson L, Donovan A, Gaffney T, Bertele V, Troll J, et al. Treatment with desmopressin acetate to reduce blood loss after cardiac surgery. A doubleblind randomized trial. N Engl J Med 1986 314(22) 1402-6. 

Shepherd LL, Hutchinson RJ, Worden EK, Koopmann CF, Coran A. Hyponatremia and seizures after intravenous administration of desmopressin acetate for surgical hemostasis. J Pediatr 1989 114(3) 470-2. 

Desmopressin acetate (DDAVP, l-desamino-8-D-argininevasopressin) is a long-acting synthetic analog of vasopressin with minimal Vi activity and an antidiuretic-to-pressor ratio 4000 times that of vasopressin. 

A dose of 1 pg desmopressin acetate has antidiuretic activity that is equivalent to 4U arginine vasopressin. Desmopressin acetate has recently been evaluated in normal horses. The author and coworkers diluted desmopressin acetate (0.1 mg/ml) nasal spray in sterile water and administered 0.05pg/kg i.v. (25 pg, equivalent to 100 U of antidiuretic activity in a 500 kg horse) to horses with polyuria induced by repeated nasogastric intubation of water for 3 days. Urine was collected for 8h after desmopressin acetate administration and there was an increase in urine specific gravity to >1.020 from 2 to 7h after administration (Fig. 10.2). The drug had no effects on heart rate or systemic blood pressure. These preliminary data demonstrate that the i.v. administration of desmopressin acetate appears to be safe and a useful tool for the evaluation of horses with DI. 

Figure 10.2 Urine osmolality and specific gravity in six horses administered 0.05 jxg/kg desmopressin acetate (DDAVP O) or placebo ( ) i.v. at time 0. The horses had polyuria induced by repeated nasogastric intubation with water (40 ml/kg) twice daily for 3 days preceding DDAVP challenge and again 4 h after administration of DDAVP. Urine was collected for 8 h after treatment and an increase in urine specific gravity to values above >1.020 was observed from 2 to 7 h after DDAVP administration.

Desmopressin Acetate. Desmopressin acetate (DDAVP.Slimale)is.synthetic l-dcsnmino-8-ivargininc va-mpressin. Ils efficacy, ease of administration (intranasal). long duration of action, and lack of side effects make il the dnig of choice for ihe treat meni of central diabetes insipidus. It may al.so be administered intramuscularly or intravenously. Il is preferred lo va.sopressin injection and oral anti-... 

Diabetes insipidus is treated by replacing the antidiuretic hormone by administering desmopressin acetate (DDAVP), desmopressin (Stimate), lypressin (Diapid), vasopressin (aqueous Pitressin), and vasopressin tannate/oil (Pitressin Tannate). 

Patients with central diabetes insipidus should be treated with intranasal desmopressin acetate, with goals of decreasing urine volume to less than 2 L/day while maintaining the serum sodium concentration between 137 and 142 mEq/L. 

FIGURE 49-5. Water deprivation test The change in plasma osmolality is plotted against the change in urine osmolality following water deprivation and subcutaneous administration of 5 meg of desmopressin acetate. DI, diabetes insipidus Posm, plasma osmolality Uosm, urine osmolality. (Adapted from Rose et al. )... 

Desmopressin acetate (DDAVP) Central and nephrogenic DI 5-20 meg intranasally every 12-24 h... 

---