Desmopressin Acetate

DDAVP

DDAVP is used for managing vasopressin-sensitive central diabetes insipidus (CDI) and for controlling polyuria and polydipsia, followed by head trauma and surgery in the pituitary region. 

Central Diabetes Insipidus (CDI) is caused due to the lack of arginine vasopressin (AVP), which is an antidiuretic hormone that acts on V2 receptors in the kidneys, thus promoting the reabsorption of water. This medication is used in children above 5 years of age and adults upto 65 years of age. It is generally advised to take the dosage as prescribed by your healthcare provider. Do not take any action without asking your doctor, as the medication has several side effects.

Product Overview

DDAVP contains desmopressin acetate, an artificial form of vasopressin hormone. It is mainly used to treat conditions such as central diabetes insipidus or bedwetting. It can also be used in patients with conditions like hemophilia A or Von Willebrand’s disease (Type I) to prevent bleeding caused by surgery or even an injury. 

Available in strengths of 60 mcg, 120 mcg, and 240 mcg, DDAVP Melt is taken orally and dissolved under the tongue without water. It is suitable for both adults and children, as prescribed by a healthcare provider. Desmopressin regulates the balance of water in the body, effectively reducing urine output and preventing dehydration. Desmopressin works by reducing urine production in the kidneys, thus helping control symptoms related to excessive urination and thirst. It also increases the levels of clotting factors in the blood, aiding in the management of bleeding disorders.

Possible side effects include headache, nausea, and stomach cramps. It is essential to follow your doctor’s advice to minimize risks. Precautions include monitoring fluid intake to avoid water intoxication and informing your healthcare provider of any medical conditions or medications that may interact with desmopressin. If a dose is missed, take it as soon as you remember, but skip it if it’s close to the next scheduled dose. In case of overdose, seek immediate medical attention. Store DDAVP Melt at room temperature, away from moisture and heat. Always follow your healthcare provider’s instructions for safe and effective use. For any concerns or questions, consult your healthcare provider for personalized guidance.

Uses of DDAVP 

It is used to treat:

• Post-Hypophysectomy Polyuria/Polydipsia
• Central Diabetes Insipidus
• Primary Nocturnal Enuresis
• Vasopressin-Sensitive Cranial Diabetes Insipidus

How to Use DDAVP?

Dosage

Strengths and Forms

DDAVP Melt is available in various forms with the following strengths:

• Oral Tablet: 60, 100, 120 & 200 mcg
• Sublingual Tablet: 27.7 & 55.3 mcg
• Injection: 4mcg/mL

Recommended Dosage for Different Patients

Central Diabetes Insipidus

• For adults and children over 5 years of age, 60 mcg thrice a day is recommended at the initial stage of the treatment. 
• Take the medication sublingually, i.e., place it under the tongue without chewing or swallowing.
• Later, the doctor will adjust the dosage according to the patient’s response.
• The daily dosage should be 120 to 70 mcg, divided equally into 2 or 3 doses in a day.
• For children, the evening dose is two times higher than the morning and afternoon doses, ensuring enough antidiuresis during sleep. 
• This dosage is not recommended for adult patients as the adults seem to sleep for a shorter duration.

Primary Nocturnal Enuresis

• It is usually recommended to take 120 mcg 1 hour prior to the bedtime.
• For patients experiencing a wet night 3 days post their initial treatment with 120 mcg dose, doctor may increase the dose.
• The dose can be adjusted up to 360 mcg to get the desired result.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

If it is an oral tablet:

• Take your medication as prescribed by your healthcare provider, with or without meals.
• Swallow the tablet as a whole with a full glass of water.
• Do not chew or crush your tablet.
• If you are facing difficulty swallowing your tablets, immediately contact your doctor.

If it is a sublingual tablet:

• Place it under your tongue one hour before going to bed.
• Do not drink water, as the tablets will quickly dissolve in the mouth without needing any fluid.
• It’s important to limit how much your child drinks after dinner, especially during the hour before bedtime and until the next morning.
• Tear off the end tab of a blister strip completely by beginning from the corner with the hand symbol.
• Tear along the perforations to remove the blister from the strip.
• Peel off the foil on each blister by pulling toward the arrow.
• Carefully take the medication out of its blister. Place it under your tongue and let it dissolve.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does DDAVP Work?

Desmopressin is characterized as an artificial version of the antidiuretic hormone arginine vasopressin. This hormone works by changing the absorbent quality of the kidney tubules to increase water reabsorption. This increase in permeability in both the distal tubules and collecting ducts appears to be caused by the stimulation of adenylcyclase activity in the kidney tubules. This synthetic hormone is more effective at reducing urine production and has a longer half-life and duration of action compared to vasopressin.

Important Safety Information

Side Effects

Common side effects of DDAVP may include:

• Headache
• Nausea
• Mild abdominal cramps
• Nasal congestion
• Flushing of the face
• Rhinitis
• Dry mouth
• Dizziness
• Weakness
• Muscle cramps
• Fever
• Itching
• Skin rash
• Red bumps on the skin (Hives)
• Joint pain
• Blurry vision

Serious side effects of DDAVP may include:

• Low sodium (Hyponatremia)
• Memory problems
• Seizures
• Breathing problems
• Swollen lymph nodes
• Swelling on the face, lips, mouth, throat or tongue
• Fast heartbeats
• High blood pressure
• Nosebleeds
• Buzzing in the ears
• Low Blood pressure
• Sudden weight gain
• Convulsions (uncontrolled shaking of the body)

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Warnings

• Hypotension & Hypertension: Using DDAVP may cause hypotension and hypertension, along with increased heart rates. So, closely monitor your BP while taking this medication, especially if you are a patient with a history of coronary artery insufficiency.
• Thrombosis Risk: If you have a condition like Type IIB von Willebrand’s disease, you are highly likely to experience platelet aggregation, thrombocytopenia, and possibly thrombosis.
• Hypersensitivity Reactions: Patients have reported hypersensitivity reactions when taking intravenous & intranasal DDAVP, along with cases of anaphylaxis with intravenous DDAVP. While it is not known whether the antibodies are produced after multiple injections, patients need to be cautious when using such medications. Monitor for any signs and symptoms of hypersensitivity reactions and talk to a medical expert right away.
• Fluid Retention: DDAVP Injection can cause your body to retain extra fluid. This can be a problem if you already have certain health conditions like heart failure or uncontrolled high blood pressure. It is not recommended for people who are at risk of increased pressure in the brain or who have had trouble urinating before. Patients should limit how much fluid they drink while using this medication.

Boxed Warning 

• FDA has issued boxed warnings for DDAVP to alert users of its severe side effects. The medication can cause hyponatremia, which can become life-threatening, leading to seizures, death, coma, and even respiratory arrest.
• If you are a patient with severe hyponatremia, having conditions like excessive fluid intake, electrolyte imbalances, using loop diuretics, or inhaled glucocorticoids, be cautious of this medication.
• Make sure that you have normal serum sodium levels before starting or continuing DDAVP.
• Closely monitor your serum sodium within 7 days or 1 month after beginning or during the treatment.

Precautions

• Inform your healthcare provider if you have any allergies or are allergic to any component of the medication. The product may contain certain inactive ingredients that can cause adverse reactions.
• If you are undergoing any medical procedure or surgery, tell your doctor or dentist about your medical history, especially of kidney problems or heart failure. 
• Before taking DDVAP, consult with your medical professional about all the products you use, including prescription and nonprescription drugs, along with herbal products.
• Do not share your medication with other people, even if they are suffering from the same condition, as it might cause serious complications.
• Do not drive or operate machinery that requires alertness, as the medication can affect your coordination.
• Older patients and children are at increased risk for certain side effects of DDAVP. So, consult with a healthcare practitioner and discuss every risk and benefit associated with the medication.
• Pregnant women should avoid taking this medication without consulting their doctor, as it is not certain whether desmopressin affects pregnancy or harms the fetus. 
• If you are a breastfeeding mother, tell your doctor before taking this medication, as it may pass into breast milk and affect the infant. 

Contraindications

DDAVP is contraindicated in patients who have:

• Hypersensitivity
• Type IIB or platelet-type (pseudo) Willebrand disease 
• Hyponatremia
• Severe liver disease
• Nephrosis
• Cardiac insufficiency
• Chronic renal insufficiency
• Congestive heart failure
• Habitual or psychogenic polydipsia
• Vomiting
• Diarrhea
• Bulimia
• Anorexia nervosa
• Adrenocortical insufficiency
• Salt losing nephropathies

Missed Dose

• If someone has missed their dose, they are advised to take the dose as soon as possible.
• If it is time for the scheduled dose, skip the missed one and continue the regular dosing.
• Do not take double medicines just to make up for the missed one.
• Try to take medications at the same time each day for effective results.
• Use medication apps or reminders to avoid skipping any doses.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

It is recommended not to take over a dose of any medication, but if you have taken an excessive amount of DDVAP, immediately seek medical assistance, as these situations can increase the risk of fluid retention, resulting in symptoms like abdominal cramps, headaches, nausea, and flushing. 

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Storage

• Store your medications in the original package at a temperature between 15º C and 25º C. 
• Keep the tablets in a dry place.
• Do not flush the medication down the toilet or pour it into the drain.
• Keep it out of reach and sight of children or pets.
• Do not keep the medicines in direct sunlight.
• Avoid keeping the medications in damp areas like the bathroom or near the sinks.
• Discard the product when it is not in use or past its expiration date.
• Read the product’s label carefully for detailed storage instructions.
• Talk to your doctor or pharmacist to know how to dispose of the medication properly.  

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

DDAVP Interactions

• Clofibrate
• Chlorpropamide
• Carbamazepine
• Demeclocycline
• Lithium
• Norepinephrine
• Loperamide
• Beclomethasone
• Betamethasone
• Budesonide
• Bumetanide
• Ciclesonide
• Cortisone
• Deflazacort
• Dexamethasone
• Ethacrynic acid
• Fludrocortisone
• Flunisolide
• Hydrocortisone
• Methylprednisolone
• Mometasone
• Prednisolone
• Prednisone
• Torsemide
• Triamcinolone
• Vamorolone

[Note: This isn’t a complete list, and there could be other drugs that interact with DDAVP. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

DDAVP Alternatives

• Hydrochlorothiazide
• Microzide
• Vasopressin
• Minirin
• Esidrix
• Aquazide H
• DDAVP Nasal

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

How is Desmopressin (DDAVP) Different from Terlipressin?

Desmopressin and terlipressin are both synthetic hormones of vasopressin, but they serve different purposes. The drug is primarily used to treat conditions like diabetes insipidus, bedwetting, and certain bleeding disorders. It works by reducing urine production and increasing water reabsorption in the kidneys. Terlipressin, on the other hand, is used to manage bleeding esophageal varices and septic shock. It causes blood vessels to compress, reducing blood flow to the affected areas. 

How quickly does Desmopressin take effect?

Desmopressin typically shows its effect within 30 minutes to an hour after using it. Its action can vary depending on the form of the medication, such as nasal spray, oral tablet, or injection. For conditions like bedwetting, diabetes insipidus, or bleeding disorders, patients may notice an improvement in symptoms within this duration. So, it’s important to follow the prescribed dosage and instructions to achieve the desired therapeutic outcome.

Can Desmopressin cause dehydration?

Yes, Desmopressin can cause dehydration if fluid intake is not properly managed. This medication reduces urine production, which can lead to water retention. If patients do not drink enough fluids, especially during hot weather or exercise, they may become dehydrated. It is crucial for patients to follow their healthcare provider’s guidance on fluid intake while using this medication to avoid dehydration. Monitoring for signs of dehydration, such as dry mouth, dizziness, and dark urine, is also important for safety.

What are the risks of long-term Desmopressin use?

Long-term use of desmopressin can cause several risks, including water retention and hyponatremia, a condition where blood sodium levels become dangerously low. Hyponatremia can lead to symptoms like confusion, headache, nausea, and, in severe cases, seizures or coma. Other potential risks include fluid imbalance and changes in blood pressure. Regular monitoring by a healthcare provider is essential to manage these risks. Patients should adhere to prescribed dosages and attend follow-up appointments to ensure safe and effective use of desmopressin over the long term.

Are there any dietary restrictions while taking Desmopressin?

While taking desmopressin, certain dietary guidelines should be followed to prevent complications. Patients are generally advised to limit fluid intake to avoid water retention and hyponatremia. Consuming a balanced diet with accurate sodium levels is also important to prevent low blood sodium. Excessive caffeine and alcohol, which can affect hydration levels, are recommended. Patients should follow their doctor’s specific instructions regarding diet and fluid intake while on desmopressin to ensure safe and effective treatment. Regular check-ups are essential for monitoring and adjusting dietary needs.

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