DDAVP (Desmopressin)
Stimate · DDAVP
Synthetic vasopressin V2-receptor agonist
Selective V2 agonist (renal water retention + Factor VIII/vWF release from endothelial Weibel-Palade bodies). NO V1 vasopressor activity at therapeutic dose.
Indications
- •Mild Hemophilia A (Factor VIII deficiency) — bleeding prophylaxis or treatment
- •Type 1 von Willebrand disease
- •Uremic platelet dysfunction (ESRD bleeding)
- •Cardiac surgery on aspirin/clopidogrel with persistent microvascular bleeding (off-label)
- •Central diabetes insipidus (different dosing)
- •Primary nocturnal enuresis
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Bleeding prophylaxis (vWD, mild Hem A) | 0.3 mcg/kg IV over 30 min, max 20 mcg | — |
| Uremic platelet dysfunction | 0.3 mcg/kg IV; effect ~4 hr; tachyphylaxis after 2-3 doses | — |
| Diabetes insipidus | 1-4 mcg IV/SC q12-24h titrated | — |
Pharmacokinetics
Onset 30 min IV; peak 90-120 min; duration 4-12 hr (hemostatic effect); tachyphylaxis after repeated doses (depleted vWF stores).
Hemodynamic effects
Vasodilation + flushing common (low V1 cross-activity at therapeutic dose). Avoid in HTN crisis or unstable angina. Hyponatremia from water retention (esp. with hypotonic fluids).
Side effects
- !Hyponatremia (water retention) — restrict fluids; can cause seizure in pediatrics
- !Flushing, headache, transient HTN
- !Hypersensitivity / anaphylaxis (rare)
- !Tachyphylaxis (effect declines after 2-3 doses in 24 hr)
Contraindications
- ×Type IIB vWD (causes thrombocytopenia)
- ×Hyponatremia or risk thereof
- ×Severe coronary artery disease (dose-related vasodilation may compromise perfusion)
- ×Children <3 months
Clinical pearls
- ★VWD: 75% of patients have Type 1 — DDAVP-responsive. Type IIB worsens with DDAVP. Type III (severe) needs Humate-P (vWF concentrate) instead.
- ★FLUID RESTRICTION required after DDAVP — patients drink to thirst can develop severe hyponatremia + seizures (especially peds).
- ★TACHYPHYLAXIS: 2-3 effective doses, then no further response × 4-7 days while endothelial vWF restocks. Plan ahead for serial procedures.
- ★PRE-OP VWD PROPHYLAXIS: Test dose 1 week before surgery to confirm response (not all Type 1 respond). Document Factor VIII + vWF activity rise.
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