DDAVP Rhinal Tube Side Effects

Generic Name: desmopressin

Note: This page contains information about the side effects of desmopressin. Some of the dosage forms included on this document may not apply to the brand name DDAVP Rhinal Tube.

Not all side effects for DDAVP Rhinal Tube may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to desmopressin: oral tablet

In addition to its needed effects, some unwanted effects may be caused by desmopressin (the active ingredient contained in DDAVP Rhinal Tube). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking desmopressin:

Rare
  • Confusion
  • convulsions
  • decreased urine output
  • dizziness
  • fast or irregular heartbeat
  • headache
  • increased thirst
  • muscle pain or cramps
  • nausea or vomiting
  • shortness of breath
  • swelling of the face, ankles, or hands
  • unusual tiredness or weakness
Incidence not known
  • Weight gain

Some of the side effects that can occur with desmopressin may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Incidence not known
  • Delusions
  • dementia
  • diarrhea

For Healthcare Professionals

Applies to desmopressin: injectable solution, nasal solution, nasal spray, oral tablet

Cardiovascular

One review of the literature found that the incidence of thrombotic events associated with the use of DDAVP to reduce blood loss and transfusion requirements in surgical patients was not significantly higher than placebo. In any case, the incidence of thrombosis is rare. One review found only 10 reports of thrombosis over a 4-year period, covering 433,000 doses of DDAVP.[Ref]

Cardiovascular side effects have infrequently included transient and slight elevations or reductions in blood pressure, a compensatory change in heart rate, and facial flushing with injections of desmopressin (DDAVP). Vasodilation and water retention have occurred. There have been rare reports of thrombotic events (acute cerebral thrombosis, acute myocardial infarction) in some patients after DDAVP injection. At least one case of fatal left coronary thrombosis has been associated with the use of DDAVP.[Ref]

Nervous system

Nervous system side effects have included seizures and/or coma as a result of severe water intoxication and hyponatremia. Other nervous system side effects have included headache and dizziness in less than 3% of patients. DDAVP nasal spray has been infrequently associated with somnolence, lethargy, paresthesias, fatigue, confusion, stupor, malaise, diaphoresis, itchy or light-sensitive eyes, insomnia, chills, warm feeling, and agitation.[Ref]

The risk factors for DDAVP-induced hyponatremia include stress, surgery, anesthesia, narcotics (endogenous release of ADH), vomiting (loss of sodium), liver disease (hindered metabolism of DDAVP), overhydration with hyponatremic fluids, and advanced age. In some cases, fluid restriction, avoidance of hyponatremic solutions, and close monitoring of serum electrolytes and urine output for at least 15 to 20 hours after the administration of DDAVP may be beneficial.[Ref]

Hematologic

Hematologic side effects have included platelet aggregation and thrombocytopenia. These have been seen almost uniquely in patients with von Willebrand's disease Type IIB (DDAVP is contraindicated in these patients).[Ref]

Local

Local side effects of injections of DDAVP have included intravenous site erythema, swelling, and burning.[Ref]

Respiratory

Respiratory side effects of intranasal DDAVP have included rhinitis, epistaxis, and nostril pain in 2% to 10% of patients. Apnea and cardiac arrest occurred in one patient.[Ref]

Gastrointestinal

Gastrointestinal side effects have included mild abdominal cramps and nausea in 2% of patients. Dyspepsia and vomiting have rarely been associated with DDAVP nasal spray.[Ref]

Hypersensitivity

Hypersensitivity reactions have rarely included anaphylaxis.[Ref]

Psychiatric

Psychiatric side effects have included a single case of paranoid psychosis associated with the use of DDAVP nasal spray.[Ref]

References

1. Pigache RM "Facial flushing induced by vasopressin-like peptides lacking pressor activity." Br J Clin Pharmacol 17 (1984): 369-71

2. Mannucci PM, Carlsson S, Harris AS "Desmopressin, surgery and thrombosis." Thromb Haemost 71 (1994): 154-5

3. "Product Information. DDAVP (desmopressin)." Rhone-Poulenc Rorer, Collegeville, PA.

4. Albert SG, Salvato-Lechner V, Joist JH "Venous thromboembolism and transient thrombocytopenia in a patient with diabetes insipidus treated with desmopressin acetate (DDAVP)." Thromb Res 50 (1988): 695-705

5. Bond L, Bevan D "Myocardial infarction in a patient with hemophilia treated with DDAVP." N Engl J Med 318 (1988): 121

6. Vermylen J, Peerlinck K "Fatal complication of desmopressin." Lancet 346 (1995): 447

7. D'Alauro FS, Johns RA "Hypotension related to desmopressin administration following cardiopulmonary bypass." Anesthesiology 69 (1988): 962-3

8. Brommer EJ, van Brummelen P, Derkx FH "Desmopressin and hypotension." Ann Intern Med 103 (1985): 962

9. Vigano GL, Mannucci PM, Lattuada A, Harris A, Remuzzi G "Subcutaneous desmopressin (DDAVP) shortens the bleeding time in uremia." Am J Hematol 31 (1989): 32-5

10. Lowe GD "Desmopressin and myocardial infarction." Lancet 1 (1989): 895-6

11. Hartmann S "Fatal complication of desmopressin - reply." Lancet 346 (1995): 447

12. Shulman LH, Miller JL, Rose LI "Desmopressin for diabetes insipidus, hemostatic disorders and enuresis." Am Fam Physician 42 (1990): 1051-7

13. Salva KM, Kim HC, Nahum K, Fallot PL "DDAVP in the treatment of bleeding disorders." Pharmacotherapy 8 (1988): 94-9

14. "Product Information. Stimate (desmopressin)." Forest Pharmaceuticals, St. Louis, MO.

15. Hjalmas K, Bengtsson B "Efficacy, safety, and dosing of desmopressin for nocturnal enuresis in Europe." Clin Pediatr (Phila) Spec No (1993): 19-24

16. Mannucci PM, Lusher JM "Desmopressin and thrombosis." Lancet 2 (1989): 675-6

17. Miller K, Atkin B, Moody ML "Drug therapy for nocturnal enuresis. Current treatment recommendations." Drugs 44 (1992): 47-56

18. Hartmann S, Reinhart W "Fatal complication of desmopressin." Lancet 345 (1995): 1302-3

19. Israels SJ, Kobrinsky NL "Serious reaction to desmopressin in a child with cyanotic heart disease." N Engl J Med 320 (1989): 1563-4

20. Sun HL, Chien CC "Thrombocytopenia and subdural hemorrhage after desmopressin administration." Anesthesiology 88 (1998): 1115-7

21. Byrnes JJ, Larcada A, Moake JL "Thrombosis following desmopressin for uremic bleeding." Am J Hematol 28 (1988): 63-5

22. McLeod BC "Myocardial infarction in a blood donor after administration of desmopressin." Lancet 336 (1990): 1137-8

23. Harris AS "Clinical experience with desmopressin: efficacy and safety in central diabetes insipidus and other conditions." J Pediatr 114 (1989): 711-8

24. Smith TJ, Gill JC, Ambruso DR, Hathaway WE "Hyponatremia and seizures in young children given DDAVP." Am J Hematol 31 (1989): 199-202

25. Asplund R, Aberg H "Desmopressin in elderly women with increased nocturnal diuresis. A short-term study." Br J Urol 72 (1993): 42-5

26. Sukhai RN "Enuresis nocturna: long term use and safety aspects of minrin (desmopressin) spray." Regul Pept 45 (1993): 309-10

27. Odeh M, Oliven A "Coma and seizures due to severe hyponatremia and water intoxication in an adult with intranasal desmopressin therapy for nocturnal enuresis." J Clin Pharmacol 41 (2001): 582-4

28. Robson WLM, Norgaard JP, Leung AKC "Hyponatremia in patients with nocturnal enuresis treated with DDAVP." Eur J Pediatr 155 (1996): 959-62

29. Stenberg A, Lackgren G "Desmopressin tablets in the treatment of severe nocturnal enuresis in adolescents." Pediatrics 94 (1994): 841-6

30. Schwab M, Wenzel D, Ruder H "Hyponatraemia and cerebral convulsion due to short term DDAVP therapy for control of enuresis nocturna." Eur J Pediatr 155 (1996): 46-8

31. Williford SL "Water intoxication in patients treated with desmopressin - reply." Pharmacotherapy 16 (1996): 970

32. Yaouyanc G, Jonville AP, Yaouyanc-Lapalle H, Barbier P, Dutertre JP, Autret E "Seizure with hyponatremia in a child prescribed desmopressin for nocturnal enuresis." J Toxicol Clin Toxicol 30 (1992): 637-41

33. Kallio J, Rautava P, Huupponen R, Korvenranta H "Severe hyponatremia caused by intranasal desmopressin for nocturnal enuresis." Acta Paediatr 82 (1993): 881-2

34. Shepherd LL, Hutchinson RJ, Worden EK, Koopmann CF, Coran A "Hyponatremia and seizures after intravenous administration of desmopressin acetate for surgical hemostasis." J Pediatr 114 (1989): 470-2

35. Humphries JE, Siragy H "Significant hyponatremia following DDAVP administration in a healthy adult." Am J Hematol 44 (1993): 12-5

36. Simmonds EJ, Mahony MJ, Little JM "Convulsion and coma after intranasal desmopressin in cystic fibrosis." BMJ 297 (1988): 1614

37. Hamed M, Mitchell H, Clow DJ "Hyponatraemic convulsion associated with desmopressin and imipramine treatment." BMJ 306 (1993): 1169

38. Beach PS, Beach RE, Smith LR "Hyponatremic seizures in a child treated with desmopressin to control enuresis. A rational approach to fluid intake." Clin Pediatr (Phila) 31 (1992): 566-9

39. Hourihane J, Salisbury AJ "Use caution in prescribing desmopressin for nocturnal enuresis." BMJ 306 (1993): 1545

40. Williford SL, Bernstein SA "Intranasal desmopressin-induced hyponatremia." Pharmacotherapy 16 (1996): 66-74

41. Robson WLM "Water intoxication in patients treated with desmopressin." Pharmacotherapy 16 (1996): 969-70

42. Weinstein RE, Bona RD, Altman AJ, Quinn JJ, Weisman SJ, Bartolomeo A, Rickles FR "Severe hyponatremia after repeated intravenous administration of desmopressin." Am J Hematol 32 (1989): 258-61

43. Sweeney JD, Hoernig LA, Behrens AN, Novak E, Swank RT "von Willebrand's variant (type II Buffalo). Thrombocytopenia after desmopressin but absence of in vitro hypersensitivity to ristocetin." Am J Clin Pathol 93 (1990): 522-5

44. Holmberg L, Nilsson IM, Borge L, Gunnarsson M, Sjorin E "Platelet aggregation induced by 1-desamino-8-D-arginine vasopressin (DDAVP) in Type IIB von Willebrand's disease." N Engl J Med 309 (1983): 816-21

45. Castaman G, Rodeghiero F, Lattuada A, Mannucci PM "Desmopressin-induced thrombocytopenia in type I platelet discordant von Willebrand disease." Am J Hematol 43 (1993): 5-9

46. Itabashi A, Katayama S, Yamaji T "Hypersensitivity to chlorobutanol in DDAVP solution." Lancet 1 (1982): 108

47. Collins GB, Marzewski DJ, Rollins MB "Paranoid psychosis after DDAVP therapy for Alzheimer's dementia." Lancet 2 (1981): 808

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