Drugs List

Therapeutic Indications

Uses

Diabetes insipidus - diagnosis
Diabetes insipidus - treatment
Fibrinolysis response testing
Haemophilia - mild to moderate
Relief of headache after lumbar puncture
Renal function testing
Von Willebrand's disease

Therapy to increase levels of Factor VIII:C and Factor VIII:Ag (vWf) in patients with mild to moderate haemophilia or von Willebrand's disease when undergoing surgery or following trauma.

To test for fibrinolytic response

Diagnosis and treatment of cranial diabetes insipidus

To establish renal concentration capacity

Treatment of headache resulting from a lumbar puncture

Administration

By intravenous, subcutaneous or intramuscular route depending on indication and/or brand.

Contraindications

Alcoholism
Decompensated cardiac insufficiency - if used for haemostasis
Fibrinolytic response testing in patients with cardiac disorder
Fibrinolytic response testing in patients with hypertension
Habitual polydipsia
Haemostatic use in patients with unstable angina
Psychogenic polydipsia
Renal function testing in patients with cardiac disorder
Renal function testing in patients with hypertension
Treatment of lumbar puncture headache in patients with cardiac disorder
Treatment of lumbar puncture headache in patients with hypertension
Von Willebrand's disease type 2B - if used for haemostasis

Precautions and Warnings

Children under 1 year
Disorder of fluid balance
Disorders aggravated by fluid retention
Predisposition to increased intracranial pressure
Asthma
Breastfeeding
Cardiovascular disorder
Cystic fibrosis
Decompensated cardiac failure
Electrolyte imbalance
Epileptic disorder
Hypertension
Migraine
Pregnancy
Renal impairment
Unstable angina

Does not reduce prolonged bleeding time in thrombocytopenia
Not all available brands are licensed for all indications
For diagnostic purposes:limit fluids for 1h before& 8h after administration
Monitor factor VIII levels: diminished response poss with subsequent doses
Monitor fluid and electrolyte status
Monitor weight and blood pressure
Pregnancy: Monitor blood pressure due to increased risk of pre-eclampsia
Renal function testing for infants under 1 should be supervised in hospital
Discontinue if signs of fluid or electrolyte imbalance occur
Discontinue immediately if hyponatraemia occurs
Advise patient not to take NSAIDs unless advised by clinician
Advise patients to avoid excessive fluid intake

In children under 1 years old, renal capacity testing should only be performed under carefully supervised conditions in hospital.

Care should be taken to prevent fluid overload hen repeated doses are used to control bleeding in haemophilia or von Willebrand's disease. Fluid should not be forced and patients should only take as much fluid as they require to satisfy thirst. Intravenous infusions should not be given 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.

Drastically reduce fluid intake and discontinue the use of desmopressin if the following is observed:
- Gradual increase in body weight
- Decrease in serum sodium to 130mmol/l
- Plasma osmolality falls below 270mOsm/kg

Desmopressin should not used in von Willebrand's Disease Type IIB as this may trigger the release of abnormal clotting factors causing platelet aggregation and pseudothrombocytopenia.

Pregnancy and Lactation

Pregnancy

Use desmopressin with caution during pregnancy.

Blood pressure monitoring is necessary due to the increased risk of pre-eclampsia. Data on 53 exposed pregnancies in women with diabetes insipidus indicate rare cases of malformations in children.

Schaefer (2015) suggests that desmopressin can be used during pregnancy as a substitution for ADH deficiency and also as an antihaemorrhagic agent (if urgently required).

Animal studies do not indicate harmful effects with respect to pregnancy or embryonal/foetal development, parturition or postnatal development.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use desmopressin with caution during breastfeeding.

Desmopressin has been shown to pass into breast milk in negligible amounts (Schaefer, 2015). It is poorly absorbed orally by the infant (desmopressin is destroyed in the GI tract by trypsin). Patients receiving desmopressin have been reported to breastfeed without apparent problems in the infant. It appears acceptable to use it during breastfeeding (Schaefer, 2015).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggression in children
Allergic reaction
Allergic skin reactions
Behavioural disturbances (children)
Convulsions
Decrease in blood pressure
Epistaxis
Facial flushing
Fluid retention
Headache
Hyponatraemia
Nausea
Stomach pain
Tachycardia
Vomiting
Weight gain

Presentation

Solution for injection containing desmopressin acetate

Drugs List

Therapeutic Indications

Uses

Diabetes insipidus - diagnosis
Diabetes insipidus - treatment
Fibrinolysis response testing
Haemophilia - mild to moderate
Relief of headache after lumbar puncture
Renal function testing
Von Willebrand's disease

Therapy to increase levels of Factor VIII:C and Factor VIII:Ag (vWf) in patients with mild to moderate haemophilia or von Willebrand's disease when undergoing surgery or following trauma.

To test for fibrinolytic response

Diagnosis and treatment of cranial diabetes insipidus

To establish renal concentration capacity

Treatment of headache resulting from a lumbar puncture

Dosage

Adults

Children

Neonates

Patients with Renal Impairment

Administration

By intravenous, subcutaneous or intramuscular route depending on indication and/or brand.

Contraindications

Alcoholism
Decompensated cardiac insufficiency - if used for haemostasis
Fibrinolytic response testing in patients with cardiac disorder
Fibrinolytic response testing in patients with hypertension
Habitual polydipsia
Haemostatic use in patients with unstable angina
Psychogenic polydipsia
Renal function testing in patients with cardiac disorder
Renal function testing in patients with hypertension
Treatment of lumbar puncture headache in patients with cardiac disorder
Treatment of lumbar puncture headache in patients with hypertension
Von Willebrand's disease type 2B - if used for haemostasis

Precautions and Warnings

Children under 1 year
Disorder of fluid balance
Disorders aggravated by fluid retention
Predisposition to increased intracranial pressure
Asthma
Breastfeeding
Cardiovascular disorder
Cystic fibrosis
Decompensated cardiac failure
Electrolyte imbalance
Epileptic disorder
Hypertension
Migraine
Pregnancy
Renal impairment
Unstable angina

Does not reduce prolonged bleeding time in thrombocytopenia
Not all available brands are licensed for all indications
For diagnostic purposes:limit fluids for 1h before& 8h after administration
Monitor factor VIII levels: diminished response poss with subsequent doses
Monitor fluid and electrolyte status
Monitor weight and blood pressure
Pregnancy: Monitor blood pressure due to increased risk of pre-eclampsia
Renal function testing for infants under 1 should be supervised in hospital
Discontinue if signs of fluid or electrolyte imbalance occur
Discontinue immediately if hyponatraemia occurs
Advise patient not to take NSAIDs unless advised by clinician
Advise patients to avoid excessive fluid intake

In children under 1 years old, renal capacity testing should only be performed under carefully supervised conditions in hospital.

Care should be taken to prevent fluid overload hen repeated doses are used to control bleeding in haemophilia or von Willebrand's disease. Fluid should not be forced and patients should only take as much fluid as they require to satisfy thirst. Intravenous infusions should not be given 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.

Drastically reduce fluid intake and discontinue the use of desmopressin if the following is observed:
- Gradual increase in body weight
- Decrease in serum sodium to 130mmol/l
- Plasma osmolality falls below 270mOsm/kg

Desmopressin should not used in von Willebrand's Disease Type IIB as this may trigger the release of abnormal clotting factors causing platelet aggregation and pseudothrombocytopenia.

Pregnancy and Lactation

Pregnancy

Use desmopressin with caution during pregnancy.

Blood pressure monitoring is necessary due to the increased risk of pre-eclampsia. Data on 53 exposed pregnancies in women with diabetes insipidus indicate rare cases of malformations in children.

Schaefer (2015) suggests that desmopressin can be used during pregnancy as a substitution for ADH deficiency and also as an antihaemorrhagic agent (if urgently required).

Animal studies do not indicate harmful effects with respect to pregnancy or embryonal/foetal development, parturition or postnatal development.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use desmopressin with caution during breastfeeding.

Desmopressin has been shown to pass into breast milk in negligible amounts (Schaefer, 2015). It is poorly absorbed orally by the infant (desmopressin is destroyed in the GI tract by trypsin). Patients receiving desmopressin have been reported to breastfeed without apparent problems in the infant. It appears acceptable to use it during breastfeeding (Schaefer, 2015).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggression in children
Allergic reaction
Allergic skin reactions
Behavioural disturbances (children)
Convulsions
Decrease in blood pressure
Epistaxis
Facial flushing
Fluid retention
Headache
Hyponatraemia
Nausea
Stomach pain
Tachycardia
Vomiting
Weight gain

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: March 2017

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Summary of Product Characteristics: Octim injection. Ferring Pharmaceuticals Ltd. Revised June 2011.

Summary of Product Characteristics: DDAVP/Desmopressin injection. Ferring Pharmaceuticals Ltd. Revised June 2011.

The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

NICE - Evidence Services
Available at: www.nice.org.uk
Last accessed: 27 June 2017.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Desmopressin. Last revised: 7 September 2013
Last accessed: 23 January 2017.