Adverse events during use of intranasal desmopressin acetate for haemophilia A and von Willebrand disease: a case report and review of 40 patients

Abstract

We report our experience with the incidence of adverse events during the use of Stimate brand intranasal desmopressin acetate (IN DDAVP) for patients with haemophilia A (HA) or von Willebrand disease (vWD) after noting two severe adverse events in one adult patient. All patients with documented vWD (type 1 or 2 A) or haemophilia A (mild, moderate or symptomatic carrier) from the Emory Comprehensive Hemophilia Center who had IN DDAVP challenge testing or were using Stimate for treatment of bleeding were evaluated for adverse events by patient report or nursing observation of clinical signs and symptoms. Forty patients were studied. Sixty-eight per cent (27/40) experienced clinical signs and/or symptoms. The majority of these symptoms were mild, however several patients reported moderate to severe side-effects and one adult patient required medical intervention for symptomatic hyponatraemia. In our experience, two-thirds of patients tested experienced adverse signs and/or symptoms with the use of Stimate; considerably higher than that reported from preliminary results in the literature. Young age did not correlate positively with adverse reactions. Severe adverse events requiring medical intervention were rare, however symptoms such as moderate to severe headache, nausea, vomiting and weakness may necessitate evaluation for hyponatraemia. This is the first report of symptomatic hyponatraemia in an adult patient with recommended dosing of Stimate. Side-effects may be minimized if patients adhere to instructions regarding fluid intake and composition while using IN DDAVP.

Successful treatment of high titer inhibitors in mild hemophilia A with avoidance of factor VIII and immunosuppressive therapy

“…Severe side-effects of intranasal desmopressin are rare [31]; however, there have been several reports of hyponatremia associated with intranasal desmopressin used to treat diabetes insipidus or enuresis [32] and one report of hyponatremia in a MHA carrier who received intranasal desmopressin to treat menorrhagia [33]. Although our patients experienced no side effects with long term intranasal desmopressin use, patients undertaking such a regimen should be counseled about symptoms associated with hyponatremia.…”

Diabetes Insipidus: A Review

“…DDAVP can be given as an intranasal spray, oral tablet or lyophilisate (melt) form [120]. A possible side effect is hyponatremia, brought on by continued ingestion of fluids despite the resolution of the polyuria, which can be avoided by allowing effects of the DDAVP to wear off before readministering [121,122]. This is especially important while monitoring patients with post surgical CDI.…”

The use of desmopressin as a hemostatic agent: A concise review

“…Because of the mild antidiuretic effect of the agent, fluid intake should be regulated in the 24 hr following administration. Fortunately, episodes of fluid overload and severe hyponatremia are rare, and most often involve the very young patients who received closely repeated infusions [67,68]. Therefore, it is generally recommended that desmopressin is used cautiously in small children or in patients with congestive heart failure.…”