Desmopressin Acetate and Caffeine

• Generic Name: desmopressin
• Dosage Forms: n.a.
• Other Brand Names: DDAVP, Nocdurna, DDAVP nasal, DDAVP Rhinal Tube, Noctiva, Stimate

Intranasally, orally, or parenterally for prevention or control of polydipsia, polyuria, and dehydration in diabetes insipidus caused by a deficiency of endogenous posterior pituitary ADH (neurohypophyseal diabetes insipidus).

Intranasal desmopressin considered drug of choice for chronic treatment of mild to severe neurohypophyseal diabetes insipidus, because of relatively long duration of action and relative lack of adverse effects.

Intranasally, orally, or parenterally for management of temporary polyuria and polydipsia associated with trauma or surgery in the pituitary region.

Not effective in controlling polyuria caused by renal disease, nephrogenic diabetes insipidus, hypokalemia or hypercalcemia; variable efficacy in controlling polyuria secondary to administration of lithium.

Orally for management of primary nocturnal enuresis.

Used alone or as an adjunct to behavioral therapy and/or other nondrug measures; may be effective in some cases refractory to standard therapies (e.g., imipramine, enuresis alarms).

Although some desmopressin intranasal preparations (i.e., solutions containing 0.1 mg/mL) initially received approval by FDA for treatment of primary nocturnal enuresis, this approval was withdrawn in 2007 because of the risk of serious hyponatremia that may result in seizures and death, particularly in children. (See Water Intoxication under Cautions.)

Treatment usually not indicated until a child reaches 6 years of age; condition will spontaneously remit in 15% of patients every year thereafter.

Rule out other possible etiologies (e.g., neurologic and/or spinal abnormalities, diabetes insipidus or diabetes mellitus, chronic renal failure, bacteriuria [especially in girls]) before initiation of drug therapy.

Generally indicated in patients with hemophilia A with factor VIII coagulant activity >5%; designated an orphan drug by FDA for this use.

Intranasally or parenterally for management of spontaneous or trauma-induced bleeding episodes (e.g., hemarthrosis, intramuscular hematoma, mucosal bleeding) in patients with mild hemophilia A.

Intranasally or parenterally for maintenance of hemostasis during surgical procedures and postoperatively when administered 30 minutes prior to scheduled procedure.

Not indicated for patients with hemophilia A with factor VIII coagulant activity ≤5%, hemophilia B, or patients with factor VIII antibodies. Use may be justified in patients with factor VIII coagulant activity between 2–5% in certain clinical situations; carefully monitor patient if drug is used in this situation.

Not effective in patients with severe hemophilia A.

Generally indicated in patients with mild to moderate classic von Willebrand disease (type 1) with factor VIII coagulant activity >5%; designated an orphan drug by FDA for this use.

Intranasally or parenterally for management of spontaneous or trauma-induced bleeding episodes (e.g., hemarthrosis, intramuscular hematoma, mucosal bleeding) in patients with mild to moderate type 1 von Willebrand disease.

Parenterally for maintenance of hemostasis during surgical procedures and postoperatively when administered 30 minutes prior to scheduled procedure in patients with mild to moderate type 1 von Willebrand disease.

Drug of choice for management of mild to moderate type 1 von Willebrand disease, especially in patients with plasma factor VIII activity >5%.

Patients with severe homozygous von Willebrand disease with factor VIII coagulant activity and factor VIII/von Willebrand antigen concentrations <1% least likely to respond; variable response in other patients depending on type of molecular defect associated with disease.

Not indicated for patients with severe type 1 von Willebrand disease or when there is evidence of an abnormal molecular form of factor VIII antigen.

May be effective for management of bleeding in some, but not all, patients with type 2A, 2M, or 2N von Willebrand disease.

Usually not used in patients with type 2B von Willebrand disease because of an increased risk of thromboembolic events and transient thrombocytopenia; although, has been effectively used in some patients with type 2B von Willebrand disease.

Not effective for management of bleeding in patients with type 3 von Willebrand disease.

Has been used IV to increase factor VIII activity and reduce bleeding time in uremic patients with prolonged bleeding times and hemorrhagic tendencies. Reduced bleeding time and normal hemostasis observed in some additional uremic patients who received IV drug before surgery or renal biopsy.

Has been used intranasally in adults and children to evaluate ability of kidneys to concentrate urine.

Has been used intranasally in a small number of patients with sickle cell anemia to induce hyponatremia resulting in decreased mean corpuscular hemoglobin concentrations and degree of sickling for the prevention and treatment of sickle cell crisis, but safety and efficacy not established.