Intranasal Desmopressin (DDAVP) for Bleeding Disorders

These instructions are for Children's Hospital of Philadelphia (CHOP) patients who are prescribed intranasal desmopressin (DDAVP) for bleeding disorders.

Important information about desmopressin:

Desmopressin, also known as DDAVP, is used to help stop bleeding in patients with type I von Willebrand's disease or mild hemophilia A.

Desmopressin causes the release of von Willebrand's antigen, the protein that carries factor VIII. It also helps the body release factor VIII into the blood vessels to make the blood clot faster. This stops bleeding more quickly.

Intranasal desmopressin comes as a nose spray. Make sure that the pharmacy gives you intranasal desmopressin that has 1.5 mg of desmopressin in each ml of fluid and 150 mcg of desmopressin per spray. Other brands of desmopressin have different concentrations and are used for different purposes.

Intranasal desmopressin is usually given before surgery or right away if bleeding occurs. A dose may be repeated if needed after 8 to 12 hours and may be given once daily thereafter. Intranasal desmopressin should not be used for more than 3 days since after this time, response to the medicine may be decreased.

The medicine begins to work about 30 minutes after it is given and has its peak effect in 2 or 3 hours. The effect may last 8 to 12 hours or longer.

Common side effects include:

  • Fluid retention

  • Redness and warmth in face

Some patients experience:

  • Runny or stuffy nose

  • Headache

  • Nausea (upset stomach)

  • Dizziness

  • Faster heart rate

Rare side effects include:

  • Changes in blood pressure

  • Blood clots

  • Seizure

Instructions for desmopressin:

  • Notify your hematology team if your child has ever had heart problems or a blood clot. Desmopressin should not be used by these patients.

  • Prime the nasal spray before the first use or if it has not been used for 1 week or more. Follow instructions on your nasal spray for priming.

  • Instruct your child to blow their nose, if they are able, to clear out any mucus before receiving intranasal desmopressin. If your child is unable to blow their nose, use a bulb-suction to remove mucus.

  • Tell your child to sniff in (if able) as the medicine is sprayed into the nose.

  • Give the prescribed number of sprays.

  • Rinse the spray tip with hot water and dry with a clean cloth or tissue.

  • If your child has a nosebleed, give the medicine into the nostril that is not bleeding. If both nostrils are bleeding, call your hematology team. In this case, it is possible that intranasal desmopressin may not be effective, and IV desmopressin may be needed to stop the bleeding.

Instructions for fluids:

  • After a dose of desmopressin, fluids need to be restricted up to 24 hours. If your child has more fluid than is allowed, their sodium levels can become dangerously low. This can cause seizures. There are no restrictions for solid food, so your child can continue to eat normally.

  • The amount of fluids allowed is based on your child's weight. Adjust slightly for exercise, heat and thirst. Fluids include IV fluids given before or after surgery.

  • Follow the guidelines below and contact your hematology team with any questions.

Weight

Fluids in 24 hours following dose desmopressin

Less than 10Kg (22lb)

Contact your hematology team for allowed amount

10-20 Kg (22-44lb)

840 mL (28 ounces = 3.5 eight-ounce glasses)

20-40 Kg (44-88lb)

960 mL (32 ounces = 4 eight-ounce glasses)

40-60 Kg (88-132lb)

1200 mL (40 ounces = 5 eight-ounce glasses)

60-80 Kg (132-176lb)

1440 mL (48 ounces = 6 eight-ounce glasses)

General safety tips:

  • You and your child should know the names of all the medicines they are taking. It is important to share this information with anyone involved in your child's care.

  • Before giving the first dose, read the label. Be sure it is what was prescribed. After a refill, if the medicine looks different to you, ask your pharmacist about it before giving it.

  • Always make sure you have enough medicine on hand. Each time you refill your prescription, check to see how many refills are left.

  • Always check the label and expiration date before giving any medicine. Do not give expired medicines. Ask your pharmacy what to do with expired or unused medicines. If there is no take-back program, empty them into the trash.

  • Store all medicines in their original container away from direct sunlight or heat. Do not store in humid places such as the bathroom. Keep them out of children's reach, locked up if possible.

  • If too much or the wrong kind of medicine is taken, call the Poison Control Center at 1-800-222-1222.

Contact your CHOP hematology team with questions, concerns or if your child has:

  • Headaches or other pain not relived by acetaminophen (Tylenol®)

  • Irritation or bleeding in the nose

  • Faster heart rate

  • Rapid weight gain

  • Continued bleeding

  • Dizziness

  • Vision problems

  • Confusion

  • Seizures

Call 911 if your child has signs of an allergic reaction such as swelling of the face, lips, tongue or throat; trouble breathing, wheezing or chest tightness. If you are concerned the reaction is related to desmopressin, call your healthcare team after symptoms resolve to discuss a plan moving forward.

Division of Hematology

215-590-3535

Hemostasis and Thrombosis Center

CHOP Main patients:
8:30am-5:00pm, Monday-Friday
215-590-3437

Voorhees patients
8:00am-4:30pm, Monday-Friday
856-435-7502

King of Prussia patients:
8:00am-4:30pm, Monday-Friday
267-425-3320

Weekends, holidays and every day after
5:00pm, all patients: 215-590-1000, ask the
hospital operator for the hematologist on call.

For non-urgent issues, send your team a message in the MyCHOP portal.

 

Reviewed on July 1, 2023, by Marylou Macdermott, MSN, CRNP; Rebecca Kendsersky, PharmD, BCPPS