Home Drug Guide Desmopressin Acetate

Drug Guide

Generic Name

Desmopressin Acetate

Brand Names Ddavp, Concentraid, Stimate, Minirin, Nocdurna, Desmopressin Acetate Preservative Free, Noctiva

Classification

Therapeutic: Hormone replacement for diabetes insipidus, management of certain bleeding disorders

Pharmacological: Vasopressin analog

FDA Approved Indications

Central diabetes insipidus
Primary nocturnal enuresis in children and adults
Bleeding disorders such as von Willebrand disease and mild hemophilia A
Noctiva (systemic treatment for nocturnal polyuria in adults)

Mechanism of Action

Desmopressin is a synthetic analog of vasopressin that acts on V2 receptors in the renal collecting ducts, increasing water reabsorption and decreasing urine volume.

Dosage and Administration

Adult: Dosage varies based on indication: typically 0.1-0.2 mg orally twice daily for nocturia, or intranasally as directed for diabetes insipidus.

Pediatric: For enuresis, 0.2 mg orally at bedtime; dosing adjustments depend on age and response.

Geriatric: Start at the lower end of dosing spectrum due to increased risk of hyponatremia.

Renal Impairment: Adjustments may be necessary; monitor serum sodium closely.

Hepatic Impairment: No specific adjustment typically required.

Pharmacokinetics

Absorption: Rapid oral and intranasal absorption.

Distribution: Widely distributed across body tissues; crosses the blood-brain barrier.

Metabolism: Limited hepatic metabolism, mainly excreted unchanged.

Excretion: Primarily renal excretion.

Half Life: 2-3 hours.

Contraindications

Hyponatremia
Renal impairment with risk of water intoxication
Uncontrolled hypertension

Precautions

Monitor serum sodium regularly during therapy, especially in older adults and those at risk of hyponatremia.
Use with caution in patients with cardiovascular disease.
Avoid in patients with a history of hyponatremia or fluid/electrolyte imbalances.

Adverse Reactions - Common

Headache (Common)
Nasal congestion (intranasal form) (Common)
Nausea (Common)

Adverse Reactions - Serious

Hyponatremia leading to seizures, coma, or death (Rare)
Water intoxication (Rare)
Anaphylactic reactions (rare, mostly with injectable forms) (Rare)

Drug-Drug Interactions

Certain antidepressants (e.g., SSRIs, TCAs)
Other drugs that affect water-electrolyte balance

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor serum sodium before and frequently during therapy; assess for symptoms of hyponatremia.

Diagnoses:

Risk for electrolyte imbalance
Disturbed fluid balance

Implementation: Administer as prescribed; educate on fluid restrictions if indicated.

Evaluation: Regularly evaluate serum sodium levels; watch for adverse effects such as headache, nausea, or neurological changes.

Patient/Family Teaching

Take medication exactly as prescribed.
Report symptoms of headache, nausea, or confusion.
Maintain fluid intake restrictions if advised.
Avoid excessive fluid intake to prevent water intoxication.

Special Considerations

Black Box Warnings:

Seizures and serious hyponatremia have been reported with use, especially when fluid intake is not appropriately restricted.

Genetic Factors: Genetic variations may affect response but are not routinely tested.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Severe hyponatremia, seizures, coma.

Treatment: Discontinue drug immediately; administer hypertonic saline if indicated; monitor electrolytes closely.

Storage and Handling

Storage: Store at controlled room temperature, 20-25°C (68-77°F).

Stability: Stable when stored properly; avoid freezing or excessive heat.