Inclusion Criteria for IV to PO Conversion: Infections that Require IV Antibiotics Must satisfy below criteria: Tolerate oral diet or enteral nutrition and/or receiving oral medications Infection does not require IV antibiotics Afebrile (< 100.4F in the last 24 hours) Received 24 hours of IV antibiotics endobj Heparin: (Minor) Desmopressin has been shown to have an additive effect on the anticoagulant activity of heparin. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. 0.3 mcg/kg IV over 15-30 minutes; for pre-op, give 30 minutes before procedure. Urea: (Minor) The manufacturer notes that the antidiuretic effect of desmopressin can be enhanced by the concomitant administration of urea. <> 3 0 obj Max IV rate (usual): 5 mg/min. If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. The recommended maintenance dose is 5 mcg/day to 30 mcg/day (0.05 mL/day to 0.3 mL/day) intranasally in single or divided doses. R8cxz. For antimicrobial interchanges: the pharmacist must notify the covering provider that the antimicrobial has been converted from IV to PO per protocol. Generic Name. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The pharmacodynamic effects of oral and intravenous desmopressin given in the daytime were similar during the first 6 h after dosing. Fluid restriction should be observed, and fluid intake should be limited to a minimum from 1 hour before administration, until the next morning, or at least 8 hours after administration. Carbetapentane; Guaifenesin; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. The necessity for repeat administration of DDAVP or use of any blood products for hemostasis should be determined by laboratory response as well as the clinical condition of the patient. Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Desmopressin Intranasal (Noctiva, low dose) Each spray delivers 0.83 to 1.66 mcg Marketed for Nocturia in adults (but other non-medication approaches are preferred) Expensive: $425/month in 2018 Desmopressin Oral Initial: 0.2 mg PO qhs Use lowest effective dose Increase as needed to 0.6 mg at bedtime VII. Then i-Vents acuity will now have a 10 to signify there is a open i-Vent. PATIENTS NOT AT INCREASED RISK FOR HYPONATREMIA: 1 spray (1.66 mcg) in either the left or right nostril approximately 30 minutes before going to bed. Response should be estimated by 2 parameters, adequate duration of sleep and adequate, not excessive, water turnover. Last updated on Sep 28, 2022. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Naproxen; Esomeprazole: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Cisplatin: (Moderate) Frequently monitor serum sodium levels if concurrent use of desmopressin and cisplatin is necessary. *L#n~i V3{kf_t.wjO_KgImL%4+GJ+Pp QsWAd._e7p!90&z {c`Kk;swZ/Nf{s~d? Proposed sites of these receptors include endothelial cells, megakaryocytes, blood monocytes, and mast cells. Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Oral to IV Conversion: The intravenous dose of levothyroxine is not the same as the oral dose. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Ketorolac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Fludrocortisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Sulindac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Formoterol; Mometasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. No statistically significant differences were detected between night and day except for terminal half-life, which was 3.1 h at night and 2.8 h in the daytime (P=0.02). Urine, for measurements of volume and osmolality, was collected in predetermined intervals before and until 12 h after dosing. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Increased Factor VIII activity is noted 30 minutes after intranasal administration, with peak activity occurring in 90 minutes to 2 hours. Vasopressin (ADH) and AnalogsVasopressin analogs, Synthetic structural analog of vasopressin (antidiuretic hormone or ADH); more potent and much longer acting than vasopressin; many dosage forms including oral, injectable, sublingual, and intranasal formsUsed for the treatment of central diabetes insipidus, primary nocturnal enuresis (PNE), spontaneous bleeding or trauma-induced hemorrhage, bleeding prophylaxis (e.g., surgical bleeding), hemophilia A or mild to moderate von Willebrand's disease, and nocturia due to nocturnal polyuria in adultsThe intranasal formulation is no longer indicated to treat PNE secondary to reports of hyponatremic-related seizures sometimes resulting in death, DDAVP, Minirin, Nocdurna, Noctiva, Stimate, DDAVP Nasal Sol: 0.1mg, 1mLDDAVP/Desmopressin/Desmopressin Acetate Intravenous Inj Sol: 1ml, 4mcgDDAVP/Desmopressin/Desmopressin Acetate Oral Tab: 0.1mg, 0.2mgDDAVP/Desmopressin/Desmopressin Acetate Subcutaneous Inj Sol: 1ml, 4mcgDDAVP/Desmopressin/Desmopressin Acetate/Minirin/Noctiva/Stimate Nasal Spray Met: 0.1mg, 0.1mL, 0.75mcg, 1mL, 1.5mg, 1.5mcgNocdurna Sublingual Tablet, SL: 27.7mcg, 55.3mcg. Intranasal: 5 to 40 mcg/day divided into 1 to 3 doses. 1 0 obj The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Ibuprofen; Famotidine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. The initial response is reproducible if DDAVP is administered every 2 to 3 days. Einstein (Sao Paulo). [33605], Initially, 10 mcg (0.1 mL) intranasally into 1 nostril, may increase to 30 mcg until the patient can sleep for an adequate period of time without incidence of polyuria. A woman who took both desmopressin and ibuprofen was found in a comatose state. Wash the rhinal tube in water and shake well, until no water is left in the tube.To avoid the spread of infection, do not use the container for more than 1 person.For 2.5 mL bottles, discard after 25 sprays (doses) because the amount delivered thereafter per spray may be substantially less than the recommended dose. The night-time dosing and daytime intravenous dose resulted in antidiuresis throughout the measuring period, while the effect of the daytime peroral dose receded after 6 h. Conclusion: In certain clinical situations, it may be justified to try desmopressin in persons with factor VIII concentrations of 2% to 5%; however, carefully monitor these patients. In certain clinical situations, it may be justified to try DDAVP in patients with factor VIII levels between 2% to 5%; however, these patients should be carefully monitored. 1 to 2 mcg subcutaneously twice a day or -, Br J Clin Pharmacol. A woman who took both desmopressin and ibuprofen was found in a comatose state. After Desmopressin is first used, a review of your child's progress and response should be made within 4 weeks. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. peak plasma concentration (Cmax) was 4 (+/- 3.85) pg/mL for the 0.83 mcg dose and 9.11 (+/- 6.90) pg/mL for the 1.66 mcg dose. Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. Monoamine oxidase inhibitors: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia and SIADH including monoamine oxidase inhibitors (MAOIs). A woman who took both desmopressin and ibuprofen was found in a comatose state. A woman who took both desmopressin and ibuprofen was found in a comatose state. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. A woman who took both desmopressin and ibuprofen was found in a comatose state. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia. Withdraw the necessary volume of DDAVP Injection from the vial and dilute by adding to the infusion bag of 0.9% Sodium Chloride Injection, USP per Table 1. Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. Desmopressin is not indicated for persons with severe classic vWD (type 1), for the treatment of hemophilia B, or in persons with factor VIII antibodies. If Desmopressin Acetate Injection 4 mcg/mL is used preoperatively, it should be administered 30 minutes prior to the scheduled procedure. Only start or resume therapy in patients with a normal serum sodium concentration. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Desmopressin acetate should not be used to treat patients with Type IIB von Willebrands disease since platelet aggregation may be induced. If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. Prior to treatment with DDAVP Injection, verify that factor VIII coagulant activity levels are >5% and exclude severe von Willebrand's disease (Type I) and presence of abnormal molecular form of factor VIII antigen. Dexamethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Fluticasone; Umeclidinium; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours. desmopressin: Dosing, contraindications, side effects, and pill The initial and terminal half-lives for desmopressin are 7.8 and 75.5 minutes, respectively, resulting in a prompt onset of action with a long duration of action. 1996 Sep;42(3):379-85 Pharmacologic: antidiuretic hormones + + + Indications + + PO, SC, IV, Intranasal: Treatment of diabetes insipidus caused by a deficiency of vasopressin. Results: stream 3 0 obj The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Diclofenac; Misoprostol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Caution should be used when coadministering these agents. 0.3 to 0.4 mcg/kg/dose IV or subcutaneously once. The tendency toward tachyphylaxis (lessening of response) with repeated administration given more frequently than every 48 hours should be considered in treating each patient. Conversion from IV to PO may reduce the need for IV access, which carries a higher risk of hospital-acquired bloodstream infections, 4 phlebitis, cellulitis, and severe adverse events associated with infiltration5 for the patient. Fluid restrictions should be observed. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. Prilocaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Bethesda, MD 20894, Web Policies See Table 1 for volume of diluent to use. IV and subcutaneously: No definitive dosing available. Careful fluid intake restrictions are required to prevent hyponatremia and water intoxication.[42295]. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Ensure the patient is compliant with fluid restrictions and intake. Desmopressin acetate 100 microgram Tablet Active Ingredient: desmopressin acetate Company: Aspire Pharma Ltd See contact details ATC code: H01BA02 About Medicine Prescription only medicine Healthcare Professionals (SmPC) Patient Leaflet (PIL) This information is for use by healthcare professionals Last updated on emc: 02 Mar 2022 Quick Links Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. A woman who took both desmopressin and ibuprofen was found in a comatose state. Do not use desmopressin as sole therapy in persons with vWD undergoing major surgery. Initially, 0.05 mg PO twice daily, then titrate to response. Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. DDAVP, Stimate (desmopressin) dosing, indications, interactions As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Desmopressin (dDAVP), a synthetic analogue of 8-arginine vasopressin (ADH), is an antidiuretic . As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Permanently discontinue for serious hypersensitivity reaction. 3 months and older: Dependent on route of administration and indication for therapy.Less than 3 months: Safety and efficacy have not been established. Although the manufacturer states that nasal congestion does not affect the absorption of intranasal desmopressin, some clinicians recommend a higher dose. dose conversion. A woman who took both desmopressin and ibuprofen was found in a comatose state. Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. During the initial titration period and continued therapy, observe and monitor closely. 1:2. DrugBank Accession Number. Indications and dose Diabetes insipidus, treatment By mouth Child 1-23 months Initially 10 micrograms 2-3 times a day, adjusted according to response; usual dose 30-150 micrograms daily. Initial dose: 0.05 mg orally twice a day or Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Ketorolac (Toradol) Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. documenting the conversion using the "IV to PO conversion" category. Patients previously receiving intranasal treatment may begin oral therapy the night following (24 hours) the last intranasal dose. 1995 Apr;42(4):373-8. doi: 10.1111/j.1365-2265.1995.tb02645.x [ PubMed ] 10646654 Yamamoto T, Fukuyama J, Fujiyoshi A. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Before Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia. once BP controlled with IV therapy switch to PO therapy at 200 mg. then 200-400mg 6-12 hours later titrating to effect. The patient should close the open nostril with a finger from the empty hand and gently inhale while the nasal applicator is pumped 1 time. Increased Factor VIII activity is noted 30 minutes after IV administration, with peak activity occurring in 90 minutes to 2 hours. Of course, hypertonic bicarbonate could also be used, as discussed last week. Would you like email updates of new search results? A woman who took both desmopressin and ibuprofen was found in a comatose state. Tachyphylaxis (lessening of response) with repeated administration (i.e., given more frequently than every 48 hours) may occur. Oral: 0.05 mg twice daily. Severe allergic reactions, including anaphylaxis, have been reported with intravenous and intranasal desmopressin. 4. 150 mcg into 1 nostril once for a total dose of 150 mcg. -. David McAuley, Pharm.D. Furosemide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. Blood pressure and pulse should be monitored during infusion. PDF Last Approval Date: Policy Title: Pharmacist-Managed Intravenous to If the patient was previously receiving desmopressin tablets, dose titration is required because intranasal desmopressin is approximately 10 to 40 fold more potent than oral (tablet) desmopressin. PDF Converting oral to intravenous or subcutaneous infusions - APPM 1990 Aug;66(2):175-6 Initiate fluid restriction during treatment with DDAVP Injection [see Warnings and Precautions (5.1), Use in Specific Populations (8.4, 8.5)]. Metolazone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. desmopressin iv to po conversion - finbi.no and transmitted securely. After oral desmopressin, concentrations above the limit of quantification (2.5 pg/ml) were only detected in 51% of the samples. Following oral administration, the onset of antidiuretic effect occurs around 1 hour and reaches a maximum at 4 to 7 hours. This site complies with the HONcode standard for trust- worthy health information: verify here. Despite low bioavailability, the pharmacodynamic effects of oral desmopressin were similar in magnitude to those after intravenous dose at night and during the first 6 h after daytime administration. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. -, BJU Int. Desmopressin is similar to a hormone that is produced in the body. Fluid restriction was to be observed, with fluid intake was limited to a minimum from 1 hour before intranasal administration, until the next morning, or at least 8 hours after administration.
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