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6.5.1 Hypothalamic & anterior pituitary hormones & antioestogens |
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Somatropin |
R |
Endocrinology |
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6.5.2 Posterior pituitary hormones and antagonists |
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Desmopressin tablets 200mcg |
R |
Paediatrics |
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Desmopressin spray 10mcg/spray |
R |
Endocrinology |
Desmopressin Acetate Protocol
Desmopressin acetate is given by intravenous infusion to:
Boost concentrations of factor VIII before surgical procedures in patients with-
Mild to moderate Haemophilia A particularly in patients whose plasma factor VIII activity is greater than 5%. The use of desmopressin may be justified in certain clinical situations, in patients whose plasma factor VIII activity is between 2-5%; these patients should be carefully monitored.
Mild to Moderate Type 1 von Willebrand's disease particularly in patients whose plasma factor VIII activity is greater than 5%.
Treat spontaneous or trauma-induced bleeding episodes in these patients.
Dose for adults and children:
Parenteral dosage: IV dose of 0.3 or 0.4 micrograms (300 - 400 nanograms) per kg body-weight; administer dose 30mins prior to surgery.
Intranasal dosage: 150 micrograms (in patients weighing less than 50kg) or 300 micrograms; administer dose 2 hours prior to surgery. (Note: Factor VIII response is less predictable than with injection)
Parenteral administration
The appropriate dose of desmopressin should be diluted in 0.9% sodium chloride injection and infused slowly over 15 to 30 minutes.
Use 50mls of normal saline for adults or children weighing more than 10kg
Use 10mls of normal saline for children weighing 10kg or less
Monitoring
During the infusion of the drug, the following should be monitored:
Blood pressure
Pulse
The following should be monitored during desmopressin therapy to ensure that an adequate response is being achieved:
Factor VIII and factor VIII/ ristocetin cofactor (von Willebrand) activities
Activated partial thromboplastin activity ( haemophilia patients only)
Factor VIII/ von Willebrand factor antigen levels (von Willebrand disease patients only)
Repeat the same dose 12 to 24 hours later if there is surgical bleeding.
Cautions/Contraindication
Desmopressin is C/I in patients with hypersensitivity to the drug
Factor VIII activity should be determined prior to initiating desmopressin therapy for hemostasis; therapy should not be relied on in patients with a factor VIII activity less than 5% of normal.
Avoid use in patients with type 2B or platelet-type (pseudo) von Willebrand disease because of risk of platelet aggregation and thrombocytopenia.
References:
Parfitt K. (Ed) Martindale: The complete drug reference. 33rd ed. London: The Pharmaceutical Press 2002
McEvoy G.K. (Ed) AHFS Drug information. Bethesda: American Society of Health-System Pharmacists 2002
Produced by:
Medicines Information Centre, South Manchester University Hospital NHS Trust, July 2003
Reviewed: June 2005
Review due: June 2006
Approved by Dr F Kanyike, Consultant Haematologist