DDAVP (2 micrograms IV q8hr) is started immediately and continued until the sodium is close to normal. Dependent on route of administration and indication for therapy. Prednisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. official website and that any information you provide is encrypted The volume of diluent is weight-based. Monoamine oxidase inhibitors: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia and SIADH including monoamine oxidase inhibitors (MAOIs). The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Naproxen; Esomeprazole: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. endobj The administration of carbamazepine prior to administration of desmopressin may act to reduce the duration of action of desmopressin. DB00035. Infusion Pump Required. Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Select one or more newsletters to continue. Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. Atenolol; Chlorthalidone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Maintenance dose range: 10 mcg/day to 40 mcg/day intranasally (0.1 mL/day to 0.4 mL/day) in 1 to 3 divided doses. I don't know why you would suddenly notice a decrease in your symptoms after 34 years. Dexamethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Patients previously receiving intranasal treatment may begin oral therapy the night following (24 hours) the last intranasal dose. Desmopressin is found in breast milk, but not in significant amounts. In a single study of postpartum women receiving a single dose of intranasal desmopressin, a marked change in plasma concentration of desmopressin was seen; however, little, if any, change in assayable desmopressin was found in breast milk. Oxaprozin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. 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 . Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Desmopressin is primarily excreted in the urine, with a significant portion excreted as unchanged drug (65% after oral and 92% after intranasal administration). Amiodarone (Cordarone) IV Infusion IV Infusion IV Infusion: A-fib rate control only . Triamterene; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Most patients require a maintenance dose of 20 mcg/day, administered as 10 mcg intranasally twice daily. Which lab value should prompt the nurse to question a medication dosage increase? Carbinoxamine; 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. Copyright 1993-2021 Brand Names. Particular attention should be paid to the possibility of the rare occurrence of an extreme decrease in plasma osmolality that may result in seizures which could lead to coma. For continuous infusions, conc. Max IV rate (usual): 5 mg/min. Flurbiprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. DDAVP Injection (Desmopressin Acetate Injection): Uses, Dosage - RxList Adjust dose based upon response to treatment estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. DDAVP will also stop bleeding in hemophilia A patients with episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas or mucosal bleeding. Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. {+/7VPerb}6Wz+>8. If used to reduce spontaneous or traumatic bleeding, doses may be repeated after 8 hours to 12 hours and once daily thereafter, if needed, based upon clinical condition and von Willebrand factor and factor VIII levels. If patient responded to 20 mcg/day, the dose was adjusted downward to 10 mcg/day to see if response could be maintained. Treatment longer than 4 to 8 weeks has not been studied. Ddavp, Nocdurna, Octostim. desmopressin (des-moe-pres-sin) DDAVP, DDAVP Rhinal Tube, DDAVP Rhinyle Drops, Octostim, Stimate. 1990 Aug;66(2):175-6 Caution should be used when coadministering these agents. Piroxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Aminophylline IV Push IV Push IV Push IV Push IV bolus infuse over 20 -30 minutes not to exceed 25 mg/min; max concentration 25 mg/ml. A woman who took both desmopressin and ibuprofen was found in a comatose state. Provide short term protection for uremic hemorrhagic tendency: 0.3 mcg/kg ivpb q8h x 2 doses (diminishing response). Infants 3 months of age and children: In general, desmopressin is contraindicated in persons with heart failure or uncontrolled hypertension because fluid retention increases the risk for worsening of underlying conditions that are susceptible to volume status. DDAVP ( desmopressin) is a synthetic analog of vasopressin (antidiuretic hormone) that promotes release of factor VIII Reversing anticoagulation and achieving hemostasis after cardiopulmonary bypass Preoperative doses may be given 2 hours prior to the scheduled procedure. 27.7 mcg sublingually once daily, 1 hour before bedtime without water. Many persons with type 2 vWD do not respond to desmopressin and require alternate treatment; however, a desmopressin trial can help confirm diagnosis and may be useful in some instances of mild bleeding in persons with type 2 vWD. 0.3 to 0.4 mcg/kg/dose IV or subcutaneously once. Determine need for repeat dosage based on laboratory response and patient's clinical condition. desmopressin iv to po conversion - hss.ge Dopamine: (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 dopamine only with careful patient monitoring. Clin Endocrinol (Oxf). 1/10 of intranasal dose; restrict fluid intake nocturnal enuresis Desmopressin is administered orally, intranasally, or parenterally (intravenous or subcutaneously). Careers. For All Patients Receiving Repeated Doses: Restrict free water intake and monitor for hyponatremia. Preserve in tight containers, protected from light. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Fatal anaphylaxis has been reported with intravenous desmopressin. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Your doctor may adjust the dose as needed. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. 2005 Apr;95(6):804-9. doi: 10.1111/j.1464-410X.2005.05405.x. It is not known whether antibodies to desmopressin injection are produced after repeated injections. Methods: The study had an open, randomised, four-way cross-over design. Fluid restriction should be observed, and fluid intake should be limited to a minimum from 1 hour before administration, until the next morning, or at least 8 hours after administration. Desmopressin is not indicated for persons with severe classic vWD (type 1), for the treatment of hemophilia B, or in persons with factor VIII antibodies. DDAVP, Minirin, Nocdurna, Stimate, +2 more. During treatment with DDAVP Injection, assess serum sodium, bleeding time, factor VIII coagulant activity, ristocetin cofactor activity, and von Willebrand antigen to ensure that adequate levels are being achieved. Dose: 0.1-1.2 mg/day PO divided bid-tid; Start: 0.05 mg PO bid; Max: 1.2 mg/day; Info: give 1st PO dose 12h after last intranasal dose when switching to PO; restrict fluid intake [parenteral route] Dose: 2-4 mcg/day SC/IV divided qd-bid; Info: parenteral dose is approx. 1. Hvistendahl GM, Riis A, Nrgaard JP, Djurhuus JC. When switching from DDAVP Tablets to DDAVP Injection, titrate dose individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) due to the large variability in both PK and PD. A woman who took both desmopressin and ibuprofen was found in a comatose state. Prior to treatment with DDAVP Injection, verify that factor VIII coagulant activity levels are >5% and exclude the presence of factor VIII autoantibodies. Decompensated Hypothyroidism ("Myxedema Coma") - EMCrit Project The initial and terminal half-lives for desmopressin are 7.8 and 75.5 minutes, respectively, resulting in a prompt onset of action with a long duration of action. -, Br J Urol. Preoperative doses may be given 2 hours prior to the scheduled procedure. Renal concentration capacity testing in children below the age of 1 year should only be performed under carefully supervised conditions in hospital. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 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. Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Desmopressin should be avoided in women with preeclampsia and those with cardiovascular disease due to the fact that oxytocin and IV fluids are often used during labor and delivery, both of which increase the risk of desmopressin-induced hyponatremia. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Use in children requires careful fluid intake restrictions to prevent possible hyponatremia and water intoxication. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Celecoxib; Tramadol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. The recommended dose for women is lower than for men because women are more sensitive to the effects of desmopressin sublingual tablet and had a higher risk of hyponatremia with the 55.3 mcg dose in clinical trials. Determine need for repeat dosage based on laboratory response and patient's clinical condition. 1. eCollection 2022. For antimicrobial interchanges: the pharmacist must notify the covering provider that the antimicrobial has been converted from IV to PO per protocol. The resultant increases in FVIII and vWF are similar to those seen with replacement therapy using blood products. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Sublingual TabletsThe patient should place the tablet under their tongue 1 hour before bedtime until it dissolves.Have the patient empty their bladder just before bedtime.Advise patients to limit the amount of water or liquids they drink from 1 hour before taking desmopressin sublingual tablet and until 8 hours after. 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. 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. For endotoxin-induced fever, IV is favored over PO acetaminophen in reducing temperature for up to . Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 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 can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Maximal dose-response increase in Factor VIII activity occurs at 0.3 to 0.4 mcg/kg desmopressin. Acetaminophen; Chlorpheniramine; Dextromethorphan; 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. Intranasal: 1 spray (1.5 mg/mL) in each nostril one time. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Chlorpheniramine; 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. After at least 7 days of treatment, the dose may be increased to 1.66 mcg, if needed, provided the serum sodium is within the normal range during treatment with the 0.83 mcg dose. Infants 3 months of age and children: IV: 100 mg IV bolus given immediately, followed by 25 to 75 mg IV every 6 hours or 200 mg/24 hours as a continuous IV infusion for the first 24 hours. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Intranasal desmopressin 300 mcg results in maximal Factor VIII and von Willebrand Factor activity levels 150% to 250% of normal. Caution should be used when coadministering these agents. Inclusion Criteria for IV to PO Conversion: Infections that Require IV Antibiotics Must satisfy below criteria: Tolerate oral diet or enteral nutrition and/or receiving oral medications Infection does not require IV antibiotics Afebrile (< 100.4F in the last 24 hours) Received 24 hours of IV antibiotics

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