Step-down therapy: changing to an oral drug that is a different compound and has different frequency, dose, or spectrum of activity. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Meloxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. PDF Information for Patients & Parents / Carers - North Tees and Hartlepool Noctiva Nasal SprayNoctiva nasal spray delivers either 0.83 mcg or 1.66 mcg of desmopressin acetate (equivalent to 0.75 mcg or 1.5 mcg of desmopressin) per spray (0.1 mL).Two sprays of the 0.83 mcg nasal spray are not interchangeable with 1 spray of the 1.66 mcg nasal spray; the 1.66 mcg/0.1 mL nasal spray should be prescribed for patients who are or will be taking the 1.66 mcg dose.Do NOT shake the bottle.Prime the nasal spray before using for the first time by pumping 5 actuations into the air away from the face. PATIENTS NOT AT INCREASED RISK FOR HYPONATREMIA: 1 spray (1.66 mcg) in either the left or right nostril approximately 30 minutes before going to bed. A woman who took both desmopressin and ibuprofen was found in a comatose state. The pharmacokinetic profile of desmopressin is biexponential. 55.3 mcg sublingually once daily, 1 hour before bedtime without water. <>/Metadata 2732 0 R/ViewerPreferences 2733 0 R>> PDF Intravenous Medication Guidelines for Adults - VCHCA IV: 0.3 mcg/kg once slowly over 15 to 30 minutes. If the product has not been used for more than 3 days, re-prime by pumping 2 actuations into the air.Instruct the patient to blow their nose, tilt the head back slightly, and insert the nasal applicator into the left or right nostril, keeping the nasal applicator upright. Max IV rate (usual): 5 mg/min. 0.3 to 0.4 mcg/kg/dose IV or subcutaneously once. common IV -> PO conversions & some dosing Flashcards | Quizlet Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. The pharmacokinetics of 400 microg of oral desmopressin in elderly patients with nocturia, and the correlation between the absorption of desmopressin and clinical effect. A Resource To Help With Changing From IV To PO Antibiotics Careful fluid intake restrictions are required to prevent hyponatremia and water intoxication.[42295]. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Drugs; . Pretreatment Testing and On-Treatment Monitoring Diabetes Insipidus Prior to treatment with DDAVP, assess serum sodium, urine volume and osmolality. Brompheniramine; Carbetapentane; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. more than 50 kg: 150 mcg in each nostril. Brand Names. doi: 10.31744/einstein_journal/2023RC0124. Response to vasopressin is mediated through two receptors: the V1 receptor, which mediates smooth muscle contraction in the peripheral vasculature, and the V2 receptor, which regulates water resorption in the collecting ducts. A woman who took both desmopressin and ibuprofen was found in a comatose state. Find medical information for DDAVP on epocrates online, including its dosing, contraindications, drug interactions, and pill pictures. Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. <> Stimate Nasal SprayStimate nasal spray delivers doses in 0.1 mL (150 mcg) increments. Desmopressin - Wikipedia Use in children requires careful fluid intake restrictions to prevent possible hyponatremia and water intoxication. Preoperative IV doses may be given 30 minutes prior to scheduled procedure. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Proposed sites of these receptors include endothelial cells, megakaryocytes, blood monocytes, and mast cells. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Oxybutynin: (Major) Hyponatremia-induced convulsions have been rarely reported when oxybutynin and desmopressin are used concomitantly. Use desmopressin nasal spray for nocturia with caution and monitoring of blood volume status in persons with New York Heart Association Class I congestive heart failure. Dosage adjustments of desmopressin may be necessary to maintain proper sodium and water balance. For the treatment of hypothyroidism of any etiology, except during the recovery phase of subacute thyroiditis; used as a replacement in primary (thyroidal), secondary (pituitary), tertiary (hypothalamic), congenital (cretinism), or acquired hypothyroidism. Also remove sticky note when IV to po is addressed. Guidelines recommend administering no more than once every 24 hours or for more than 3 consecutive days to minimize risk of hyponatremia and seizures. For continuous infusions, conc. Dosage form: injection Caution should be used when coadministering these agents. Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. Persons with conditions associated with fluid and electrolyte imbalance (i.e., cystic fibrosis, heart failure, renal disorders), habitual or psychogenic polydipsia who may drink excessive amounts of water as well as elderly or pediatric (e.g., infants, children) patients and those receiving concomitant drugs that also cause hyponatremia may be at increased risk of hyponatremia. Prednisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Following oral administration, the bioavailability of desmopressin is about 5% and 0.16% compared to intranasal and intravenous administration, respectively. Desmopressin | Drugs | BNF | NICE C. The pharmacist must enter Epic order comments stating "IV to PO Conversion per P&T policy for all interchanged orders. eCollection 2022. In the elderly, careful fluid intake restrictions are required to prevent hyponatremia and water intoxication. Caution should be used when coadministering these agents. 2022 Mar 2;12(3):389. doi: 10.3390/biom12030389. administration route. The mechanism of action of desmopressin in If 30 mcg is divided, typically 20 mcg is given in the morning, and 10 mcg is given at night. In adults and children weighing more than 10 kg, 50 mL of diluent is recommended; in children weighing 10 kg or less, 10 mL of . endobj A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Antidiuretic effects usually occur within 15 to 60 minutes, with peak effects evident 1 to 5 hours after nasal administration. Individualize dosing to prevent an excessive decrease in plasma osmolality, which can lead to hyponatremia and possible seizures. IN 1977 DESMOPRESSIN (1-deamino-8-D-arginine vasopressin, abbreviated DDAVP), a derivative of the antidiuretic hormone, was used for the first time to treat patients with hemophilia A and von Willebrand disease (vWD), the most frequent congenital bleeding disorders. Blood pressure and pulse should be monitored during infusion. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Desmopressin systemic 0.1 mg (232 0.1 barr). A woman who took both desmopressin and ibuprofen was found in a comatose state. Do not transfer any remaining solution to another bottle. Tilt bottle so that the tube inside the bottle draws from the deepest portion of the medication.To avoid the spread of infection, do not use the container for more than 1 person.For 5 mL bottles, discard after 50 sprays (doses), and for 2.5 mL bottles, discard after 25 sprays (doses) because the amount delivered thereafter per spray may be substantially less than the recommended dose. Intranasal: 1 spray (1.5 mg/mL) in each nostril one time. According to the Beers Criteria, desmopressin is considered a potentially inappropriate medication (PIM) in geriatric adults and avoidance is recommended for treating nocturia or nocturnal polyuria because there is a high risk of hyponatremia and safer alternatives are available. 100 unit / 100 ml (1 unit/ml). Desmopressin is similar to a hormone that is produced in the body. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours. If the patient was previously receiving desmopressin injection, administer 10 times the amount of desmopressin acetate, rounding down to the nearest 10 mcg. 0.2 to 0.6 mg orally once daily before bedtime. Bookshelf Desmoperssin is the drug of choice for treatment of central diabetes insipidus and most commonly it is used as intranasal spray. During the initial titration period and continued therapy, observe and monitor closely. Sodium is corrected by infusing hypertonic solutions, primarily 3% saline. Bioavailability was estimated using AUC(0-->t) for the oral and the intravenous periods. Median time to reach Cmax (tmax) was 1.5 (range 1.0-4.1) h at night and 1.5 (range 0.5-3.0) h in the day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Ketorolac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. 2022 Mar 8;7(1):e000852. Consider risk vs. benefit as pregnant women with Hemophilia A or von Willebrand's disease as these patients may be at an increased risk for bleeding diatheses and hemorrhagic events at delivery; affected neonates may also be at risk of bleeding diatheses. To prime, press down 4 times. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Fluticasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. When switching between formulations, the below text is meant as guidance for starting dose. Acetaminophen; Guaifenesin; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. For bleeding, desmopressin increases the blood levels of factor VIII and von Willebrand . If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Chlorothiazide: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Some studies have used 0.1 to 1 mcg IV/SC in 1 or 2 divided doses. desmopressin iv to po conversion - hss.ge xTMk1?DFh!PiHhmz(=lk;p"v< Fobt7t?@IFT];XaYV={~w ^JLAIIG\G\m$XJe@xH8!ZDhrN*'VH4'J.cq 'A%;v}q+i+&L 44qDxR)o3 Desmopressin acetate 100 microgram Tablet Active Ingredient: desmopressin acetate Company: Aspire Pharma Ltd See contact details ATC code: H01BA02 About Medicine Prescription only medicine Healthcare Professionals (SmPC) Patient Leaflet (PIL) This information is for use by healthcare professionals Last updated on emc: 02 Mar 2022 Quick Links Increased Factor VIII activity is noted 30 minutes after IV administration, with peak activity occurring in 90 minutes to 2 hours. If the patient was previously receiving desmopressin tablets, dose titration is required because intranasal desmopressin is approximately 10 to 40 fold more potent than oral (tablet) desmopressin. Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Dilution Desmopressin (DDAVP ) - GlobalRPH Chlorthalidone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. In general, dose selection for the geriatric patient should be cautious, usually starting at the low end of the dosing range. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia. Persons with vWD type 1 and von Willebrand factor (vWF) concentrations less than 0.3 International Units/mL or factor VIII activity equal to or less than 5% of normal may not respond to desmopressin. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Treatment with ddAVP improves platelet-based coagulation in a rat model of traumatic hemorrhagic shock. Guidelines describe preemptive desmopressin administration to prevent sodium overcorrection. Fluticasone; Umeclidinium; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Most patients require a maintenance dose of 20 mcg/day, administered as 10 mcg intranasally twice daily. To minimize risk of hyponatremia and seizures, administer no more than once every 24 hours or for more than 3 consecutive days. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Desmopressin increases plasma factor VIII (FVIII) and von Willebrand factor (vWF) to a greater extent than equivalent weights of vasopressin. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. When DDAVP /Desmopressin Injection is used for diagnostic purposes, fluid intake must be limited and not exceed 0.5 litres from 1 hour before until 8 hours after administration. In patients receiving desmopressin nasal spray for nocturia, discontinue treatment in patients with concurrent nasal conditions that may increase systemic absorption of desmopressin (e.g., atrophy of nasal mucosa, and acute or chronic rhinitis), because the increased absorption may increase the risk of hyponatremia. Rapid IV bolus DDAVP (Desmopressin Acetate Tablets): Uses, Dosage, Side - RxList This increase is dose-dependent, with an IV dosage of 0.4 mcg/kg producing a 300% to 400% maximum increase in Factor VIII activity. Missed Dose Azelastine; Fluticasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Benzodiazepine Equivalents Conversion Calculator - ClinCalc.com Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. > = 12 years and adult: 2-4 mcg/day IV/SC divided BID or 1/10 of the . 150 mcg into each nostril once for a total dose of 300 mcg. . DDAVP (2 micrograms IV q8hr) is started immediately and continued until the sodium is close to normal. On Day 7, 6 subjects were given a single SC bolus injection of desmopressin. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Diclofenac; Misoprostol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. CrCl 50 mL/minute or more: No dosage adjustment is needed.CrCl less than 50 mL/minute OR eGFR less than 50 mL/minute/1.73 m2: Use is contraindicated. Determine need for repeat dosage based on laboratory response and patient's clinical condition. Levels of FVIII are also increased, which increases hemostasis by accelerating fibrin formation. For patients who have been controlled on intranasal desmopressin acetate and who must be switched to the injection form, either because of poor intranasal absorption or because of the need for surgery, the comparable antidiuretic dose of the injection is about one-tenth the intranasal dose. May repeat dose if needed. 4 0 obj Initiate at low dose and increase as necessary. Determine need for repeat dosage based on laboratory response and patient's clinical condition. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Desmopressin is present in small amounts in human milk and is poorly absorbed by an infant. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 1 After the original clinical study performed in Italy, desmopressin was used in Some have suggested an initial dosage range of 0.1 to 1 mcg in 1 or 2 divided doses. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. If patient responded to 20 mcg/day, the dose was adjusted downward to 10 mcg/day to see if response could be maintained. e-N;CM_[9,jPUO'@O%W]I,7wO;~ -O{GOiZb]]qJy=q4/I3>1&p#!EoA2hF"H kn.u,yQg Desmopressin is not effective in persons with type 3 von Willebrand's disease (vWD) and can cause platelet aggregation, thrombocytopenia, and possibly thrombosis in persons with type 2B vWD. In additio This site needs JavaScript to work properly. DDAVP Injection (desmopressin acetate) is a man-made form of a hormone that occurs naturally in the pituitary gland used to treat hemophilia A or von Willebrand's disease Type I, and is also used to treat central cranial diabetes insipidus, and increased thirst and urination caused by head surgery or head trauma. Clin Endocrinol (Oxf). The risk of toxic reactions (including water intoxication and low sodium concentrations) appears to be greater in the geriatric patient and other patients with impaired renal function. Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. September, 2004 Hospira 2004 EN-0511 Printed in USA HOSPIRA, INC., LAKE FOREST, IL 60045 USA. Med Surg ATI Proctored Exam Test Bank A 1 2 0 obj Diabetes insipidus: 2-4 mcg/day IV push or SC. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. In certain clinical situations, it may be justified to try desmopressin in persons with factor VIII concentrations of 2% to 5%; however, carefully monitor these patients. If there is no response, the medication will be stopped. Blood pressure and heart rate monitoring during infusion is recommended. The optimal dosage depends on the patient's response (duration of sleep and adequate, not excessive water turnover). HHS Vulnerability Disclosure, Help A pharmacokinetic and pharmacodynamic comparison of desmopressin administered as whole, chewed and crushed tablets, and as an oral solution. No adverse developmental outcomes were observed in animal reproduction studies with administration of desmopressin during organogenesis to pregnant rats and rabbits at doses approximately less than 1 and 38 times, respectively, the maximum recommended human dose based on body surface area (mg/m2). Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The volume of diluent is weight-based. Propranolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Fluid restrictions should be observed. desmopressin (des-moe-pres-sin) DDAVP, DDAVP Rhinal Tube, DDAVP Rhinyle Drops, Octostim, Stimate. 2005 Oct;27(5):655-65. doi: 10.1097/01.ftd.0000168293.48226.57. 1 0 obj Budesonide; Formoterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Carbetapentane; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
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