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Desmopressin (Synthetic Arginine Vasopressin) (DDAVP, Stimate)

- For Diabetes Insipidus (intranasal & parental); bleeding due to hemophilia A and Type I von Willebrand's dz (parental); bleeding from esophageal varices; head trauma;
     - it can transiently correct the bleeding time in most patients with chronic renal failure and other acquired disorders of platelet function;
- DI: Intranasally: Adult: 0.1-0.4 mL (10-40 ug) daily in 2-3 divided doses;
- Peds: (3 mo-12yr): 0.05-0.3ml qd in 2-3 divided doses;
- Parentally: Adult: 0.5-1.0 ml (2-4 ug) qd in 2-3 DD; if converting from intranasal to parental doseing, use 1/10th intranasal dose;
- Hemophilia A and von Willebrand's dz (Type I):  Adults and Peds: > 10 kg: 0.3 ug/kg diluted to 50 ml with NSS infused slowly over 15-30 min;
- Peds < 10 kg: same as above with dilution to 10 ml with NS;
- Bleeding from esophageal varices: IV infusion of 0.2-0.4 U/min with max rate of 0.9 u/min;
- Note: in vary young and old patients, adjust fluid intake to avoid water intoxication;
Synthetic Arginine Vasopression (DDAVP)
Indications: Diabetes insipidus (intranasal and parental); bleeding due to Hemophilia A and Type I Von Willebrand's disease (parental); Bleeding from esophageal varices; Head Trauma;
   Dosage: DI: Intranasal: Adult: 0.1 - 0.4 ml (10-40 ug) qd in 2-3 DD;
               Parental  : Adult: 0.5 - 1.0 ml (2-4 ug) qd in 2-3 DD;
               Hemophilia: Adult: 0.3 ug/kg diluted to 50 ml w/ NS infused slowly over 20 min.
               Von Wille's Same as above:
               Esophageal Bleeding: IV: 0.2-0.4 U/min; Max: 0.9 u/min;
- Note: avoid Water Intoxication and Hyponatremia;
- although desmopressin therapy is usually well tolerated, it does carry small risk of serious complications, particularly in association with hyponatremia in infants and arterial thrombosis in elderly patients;
- Renal Failure: Patients:
   - bleeding of uremic patients can be shortened by administration of conjugated estrogens or DDAVP, reinforcing speculation that inter-
        action between platlets and factor VIII and vWF is the primary hemo-static defect in uremia;
   - in some uremic patients, prolonged bleeding times can be markedly shortened by simply raising the hematocrit

Desmopressin decreases operative blood loss in spinal cord injury patients having flap reconstruction of pelvic pressure sores.

Effects of desmopressin on blood loss in hip arthroplasty. Controlled study in 50 patients.