DDAVP

Treatment of Cranial Diabetes Insipidus:

By subcutaneous, itntramuscular or intravenous injection Adults: The usual dose is 1 to 4 micrograms given once daily. 4 micrograms (0. lml) may be used.

Diagnosis of Cranial Diabetes Insipidus:

The diagnostic dose in adults and children is 2 micrograms given by subcutaneous or intramuscular injection. Failure to elaborate a concentrated urine after water deprivation, followed by the ability to do so after the administration of Desmopressin confirms a diagnosis of cranial diabetes insipidus.

Failure to concentrate after the administration suggests nephrogenic diabetes insipidus.

Mild to moderate haemophilia and von Willebrand’s disease:

By intravenous administration. 4 micrograms per kilogram body weight administered by intravenous infusion. Further doses may be administered at 12 hourly intervals so long as cover is required. As some patients have shown a diminishing response to successive doses, it is recommended that monitoring of Factor VIII levels should continue.

9% sodium chloride for injection and given over 20 minutes. This dose should be given immediately prior to surgery or following trauma. During administration of intravenous Desmopressin, vasodilation may occur resulting in decreased blood pressure and tachycardia with facial flushing in some patients.

Increase of Factor VIII levels are dependent on basal levels and are normally between 2 and 5 times the pretreatment levels. If results from a previous administration of Desmopressin are not available then blood should be taken pre-dose and 20 minutes post-dose for assay of Factor VIII levels in order to monitor response.

Unless contraindicated, when surgery is undertaken, tranexamic acid may be given orally at the recommended dose from 24 hours beforehand until healing is complete.

Renal Function Testing:

By subcutaneous or intramuscular injection. Adults and children can be expected to achieve urine concentrations above 700mOsm/kg in the period of 5 to 9 Hours following a dose of 2 micrograms DDAVP 4 micrograms/ml Injection. It is recomended that the bladder should be emptied at the time of administration.

Side-effects include headache, stomach pain and nausea. Isolated cases of allergic skin reactions and more severe general allergic reactions have been reported. Very rare cases of emotional disorders including aggression in children have been reported.

Treatment with Desmopressin without concomitant reduction of fluid intake may lead to water retention/hyponatraemia with accompanying symptoms of headache, nausea, vomiting, weight gain, decreased serum sodium and in serious cases, convulsions.

Precautions:

GENERAL: Precautions to prevent fluid overload must be taken in -conditions characterised by fluid and/or electrolyte imbalance -patients at risk for increased intracranial pressure Care should be taken with patients who have reduced renal function and/or cardiovascular disease or cystic fibrosis.

5 litres from 1 hour before until 8 hours after administration. Renal concentration capacity testing in children below the age of 1 year should only be performed under carefully supervised conditions in hospital.

FOR HAEMOSTATIC USE:

When repeated doses are used to control bleeding in haemophilia or von Willebrand's disease, care should be taken to prevent fluid overload. Fluid should not be forced, orally or parenterally, and patients should only take as much fluid as they require to satisfy thirst.

Intravenous infusions should not be left up as a routine after surgery. Fluid accumulation can be readily monitored by weighing the patient or by determining plasma sodium or osmolality. Measures to prevent fluid overload must be taken in patients with conditions requiring treatment with diuretic agents.

Special warnings:

Special attention must be paid to the risk of water retention. The fluid intake should be restricted to the least possible and the body weight should be checked regularly. If there is a gradual increase of the body weight, decrease of serum sodium to below 130mmol/l or plasma osmolality to below 270mOsm/kg, the fluid intake must be reduced drastically and the administration of DDAVP 4 micrograms/ml Injection interrupted.

During infusion of DDAVP 4 micrograms/ml Injection for haemostatic use, it is recommended that the patient's blood pressure is monitored continuously. DDAVP 4 micrograms/ml Injection does not reduce prolonged bleeding time in thrombocytopenia.

DDAVP 4 micrograms/ml Injection is contraindicated in cases of:

GENERAL: -habitual and psychogenic polydipsia RENAL FUNCTION TESTING, TREATMENT OF LUMBAR PUNCTURE HEADACHE OR FIBRINOLYTIC RESPONSE TESTING: -should not be carried out in patients with hypertension, heart disease, cardiac insufficiency and other conditions requiring treatment with diuretic agents FOR HAEMOSTATlC USE: -unstable angina pectoris -decompensated cardiac insufficiency -von Willebrand's Disease Type IIB where the administration of Desmopressin may result in pseudothrombocytopenia due to the release of clotting factors which cause platelet aggregation.