Desmopressin, DDAVP/Nocturna (US/CDN)/Stimate (US)/Octostim (CDN)
Description: Antihemophilic Agent; Hemostatic Agent; Synthetic Posterior Pituitary Hormone; Vasopressin Analog
“ALERT: US Boxed Warning
Hyponatremia (Nocdurna, Noctiva nasal spray):
Desmopressin can cause hyponatremia. Severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest, or death. Desmopressin is contraindicated in patients at increased risk of severe hyponatremia, such as patients with excessive fluid intake, illnesses that can cause fluid or electrolyte imbalances, and in those using loop diuretics or systemic or inhaled glucocorticoids. Ensure serum sodium concentrations are normal before starting or resuming desmopressin. Measure serum sodium within 7 days and ~1 month after initiating therapy or increasing the dose and periodically during treatment. More frequently monitor serum sodium in patients ≥65 years of age and in patients at increased risk of hyponatremia. If hyponatremia occurs, desmopressin may need to be temporarily or permanently discontinued.”
CSA NA – FDA Approved – REMS (N) – Can Ship
How Does It Work
Desmopressin, DDAVP/Nocturna/Stimate/Octostim is a synthetic analogue of the antidiuretic hormone arginine vasopressin. Desmopressin increases cyclic adenosine monophosphate (cAMP) in renal tubular cells which increases water permeability resulting in decreased urine volume and increased urine osmolality. It also increases plasma levels of von Willebrand factor, factor VIII, and t-PA contributing to a shortened activated partial thromboplastin time (aPTT) and bleeding time.
Indications For Use
Diabetes Insipidus, Hemophilia A, Von Willebrand Disease (Type 1), Uremic Bleeding, Nocturia, Primary Nocturnal Enuresis
Before starting Desmopressin, DDAVP/Nocturna/Stimate/Octostim make sure your physician is aware of any allergies and medications you currently take, if you have hyponatremia or a history of hyponatremia, cardiovascular disease, a history of polydipsia, are pregnant, or breastfeeding. Desmopressin has been associated with rare but serious side effects such as fluid retention, allergic reactions, extreme hyponatremia, hypotension, and thrombotic events. Patients with type 2B von Willebrand disease requiring hemostasis should not be treated with desmopressin since may result in platelet aggregation, thrombocytopenia, and possibly thrombosis.
Refer to product monograph as dosing is complex and varies greatly with the condition it is being used for. It is available in various preparations such as oral tablet, sublingual tablets, nasal sprays, and injections.
Pharmacist Tips On Using
How to Take:
Oral, tablet: May administer with or without food. Food may reduce/delay absorption although does not affect the antidiuretic activity
Sublingual: Keep a tablet under the tongue until completely dissolved.
You Need to Avoid: Avoid excessive intake of water due to increased risk of hyponatremia. Fluid restrictions may be recommended depending on patient status and diagnosis.
Generally, well-tolerated with the most common side effects being hyponatremia and xerostomia (dry mouth).
Note this is not a complete list of side effects for Desmopressin, DDAVP/Nocturna/Stimate/Octostim only common ones.
Frequently Asked Questions
What do I do if side effects are intolerable?
If side effects are causing a lot of distress speak to your physician as soon as possible to discuss options.