Westmorland General Hospital Ward 7, Articles D

Provide short term protection for uremic hemorrhagic tendency: 0.3 mcg/kg ivpb q8h x 2 doses (diminishing response). Fill in the blank - Do not enter the label - Rounding - Verify answer - Conversions - Practice questions. For All Patients Receiving Repeated Doses: Restrict free water intake and monitor for hyponatremia. eCollection 2022. The recommended maintenance dose is 10 mcg/day to 40 mcg/day intranasally (0.1 mL/day to 0.4 mL/day) in 1 to 3 divided doses. 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. Initially, 0.05 mg PO twice daily. Initially, 0.05 mg PO twice daily, then titrate to response. Objective: Tricyclic antidepressants: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. The usual dosage range is 0.1 mg to 1.2 mg PO per day, given in 2 to 3 divided doses. 8-10 mg IV = 40 mg PO. hydrochlorothiazide, nortriptyline, tranexamic acid, imipramine, desmopressin, Pamelor, Microzide, vasopressin, Tofranil. When switching between formulations, the below text is meant as guidance for starting dose. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. BJU Int. Tolmetin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. government site. DrugBank Accession Number. 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). Rotoli BM, Visigalli R, Ferrari F, Ranieri M, Tamma G, Dall'Asta V, Barilli A. Biomolecules. Only start or resume therapy in patients with a normal serum sodium concentration. Caution should be used when coadministering these agents. 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. Methods: The study had an open, randomised, four-way cross-over design. Selective serotonin reuptake inhibitors: (Minor) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including SSRIs. The antidiuretic effects of the drug last for about 5 to 21 hours, followed by an abrupt cessation of activity that occurs over a 60- to 90-minute period. IV Push for Hyperkalemia. Patients changing from intranasal desmopressin: The recommended starting dose of DDAVP Injection is 1/10th the daily maintenance intranasal dose administered by subcutaneous or intravenous injection as one or two divided doses. 27.7 mcg sublingually once daily, 1 hour before bedtime without water. It is not known whether antibodies to desmopressin injection are produced after repeated injections. Desmopressin Stimulates Nitric Oxide Production in Human Lung Microvascular Endothelial Cells. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. If the product has not been used for a period of 1 week, re-prime the pump by pressing once.Instruct patient on the proper technique for administering the nasal spray. Aminophylline IV Push IV Push IV Push IV Push IV bolus infuse over 20 -30 minutes not to exceed 25 mg/min; max concentration 25 mg/ml. IV: 0.3 mcg/kg by slow infusion over 15 to 30 minutes beginning 30 minutes before procedure. Doses may be titrated up to 0.6 mg PO once daily at bedtime, depending on individual patient response. When switching from DDAVP Tablets to DDAVP Injection, titrate dose individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) due to the large variability in both PK and PD. Increased Factor VIII activity is noted 30 minutes after intranasal administration, with peak activity occurring in 90 minutes to 2 hours. Factors associated with mortality of myxedema coma: report of eight cases and literature survey. It may be given in the nose, by injection into a vein, by mouth, or under the tongue. Ther Drug Monit. Fluticasone; Umeclidinium; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Diphenhydramine; Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Oral: 0.05 mg twice daily. After Desmopressin is first used, a review of your child's progress and response should be made within 4 weeks. Desmopressin is similar to a hormone that is produced in the body. Longer DOA. 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. When switching from DDAVP Nasal Spray to DDAVP Injection, the starting dose is one-tenth times the DDAVP Nasal Spray dose. DDAVP will also stop bleeding in hemophilia A patients with episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas or mucosal bleeding. To prime, press down 4 times. Monitor patients for signs or symptoms of hypersensitivity reactions during administration, interrupt treatment should a reaction occur, and manage medically. Drug class: Antidiuretic hormones. Prepare the solution for infusion using aseptic technique. Dose should be reduced. %PDF-1.5 The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Vincristine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including vincristine. Other evaluations have indicated that the terminal half-life for desmopressin is approximately 3 hours. 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. The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced. Desmopressin nasal spray can be resumed when these conditions resolve. Articaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Ddavp, Nocdurna, Octostim. A woman who took both desmopressin and ibuprofen was found in a comatose state. Oral to IV conversion (approximate): oral dose x 0.625 = daily IV dose.. HYDROCORTISONE (SOLU CORTEF) 0 to 100mg/ 100 ml 101 to 150 mg/ 150. minlinklosubs - Hydrocortisone iv to po steroid dosing conversion. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Desmopressin is contraindicated in persons with moderate to severe renal impairment (CrCl less than 50 mL/minute or eGFR less than 50 mL/minute/1.73 m2) and renal failure. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. 1999 Dec;84 Suppl 1:5-8 Following an intranasal dose of 1.66 mcg of desmopressin for nocturia, the median apparent terminal half-life was 2.8 hours; the half-life range in patients with an eGFR above 50 mL/minute/1.73 m2 was 1.4 to 3.8 hours. Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. A woman who took both desmopressin and ibuprofen was found in a comatose state. 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 works by limiting the amount of water passed in the urine. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Chlorthalidone; Clonidine: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Guardrail Drug Requires documentation of two (2) RN's for double-checking. The administration of carbamazepine prior to administration of desmopressin may act to reduce the duration of action of desmopressin. Find medical information for DDAVP on epocrates online, including its dosing, contraindications, drug interactions, and pill pictures. 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. 2020 Aug;22(4):369-383. doi: 10.1007/s40272-020-00401-7. Example: Ampicillin-sulbactam 1.5gm IV Q6H to amoxicillin-clavulanic acid 875mg/125mg PO Q12H. There is no information on the effects of desmopressin on the breast-fed infant or on milk production. Oral bioavailability: the amount of drug that enters systemic circulation when that drug is consumed orally. Ethacrynic Acid: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. Clin Endocrinol (Oxf). -The most preferred drug is desmopressin acetate (DDAVP), a synthetic form of vasopressin given orally, as a sublingual "melt," or intranasally in a metered spray. You may require 10 to 20 times a greater dose of desmopressin with the tablet oral formulations than with the nasal formulations. Persons with renal disease may be at increased risk for low sodium concentrations, fluid overload, and electrolyte abnormalities. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. A woman who took both desmopressin and ibuprofen was found in a comatose state. IV and subcutaneously: No definitive dosing available. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Monitor patients closely during the initial dose titration period. Blood pressure and pulse should be monitored during infusion. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Adjust dose based upon response to treatment estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. [33605], Initially, 10 mcg (0.1 mL) intranasally, given in 1 to 3 divided doses, then titrated to response. Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. wt. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. <> 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. Repeat administration should be determined by laboratory response and clinical condition of the patient. 2022 Feb 18;14(4):1057. doi: 10.3390/cancers14041057. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Desmopressin Acetate Injection 4 mcg/mL dosage must be determined for each patient and adjusted according to the pattern of response. This medication helps to control increased thirst and too much urination due to these conditions . 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. Initiate at low dose and increase as necessary. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. 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. 55.3mcg of desmopressin acetate (equivalent to 50 mcg of desmopressin) Diabetes Insipidus Intranasal (DDAVP) Indicated as antidiuretic replacement therapy in the management of central cranial. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Persons with vWD subtype 1C, which is characterized by a shorted vWF half-life, may require alternative management in the setting of surgery. Desmopressin: Corticosteroids (Systemic) may enhance the hyponatremic . Last updated on Sep 28, 2022. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Lansoprazole; Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. A systematic review of 30 studies of desmopressin for the treatment and prophylaxis of bleeding disorders in pregnancy (n = 216) concluded that the drug is effective in reducing bleeding complications associated with pregnancy and childbirth with a good safety record. Intermittently during treatment, assess serum sodium, urine volume and osmolality or plasma osmolality. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 1 After the original clinical study performed in Italy, desmopressin was used in Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Intranasal: 1 spray (1.5 mg/mL) in each nostril one time. An official website of the United States government. Treatment has been given safely to pediatric patients for up to 6 months. 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. The pump will stay primed for up to 1 week. eCollection 2023. ADH activity : Pressor activity [DDAVP: 2000-4000: 1 Vasopressin: 1:1]. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Plasminogen activator activity increases after intravenous desmopressin, but clinically significant fibrinolysis has not been detected in patients treated with desmopressin. 1. Bumetanide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Chlorpheniramine; 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. Following oral administration, the bioavailability of desmopressin is about 5% and 0.16% compared to intranasal and intravenous administration, respectively. desmopressin (des-moe-pres-sin) DDAVP, DDAVP Rhinal Tube, DDAVP Rhinyle Drops, Octostim, Stimate. More than 50 kg: 150 mcg in each nostril. Desmopressin is contraindicated in persons with hyponatremia or a history of hyponatremia, polydipsia, concomitant loop diuretic or systemic or inhaled corticosteroid therapy, known or suspected syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and other illnesses that can cause fluid and electrolyte imbalance, such as gastroenteritis, salt-wasting nephropathies, or systemic infection. Generic name: DESMOPRESSIN ACETATE 4ug in 1mL Dosage form: injection Drug class: Antidiuretic hormones Medically reviewed by Drugs.com. Every 3 months, Pharmacokinetics and pharmacodynamics in clinical use of scopolamine. In a single study of postpartum women receiving a single dose of intranasal desmopressin, a marked change in plasma concentration of desmopressin was seen; however, little, if any, change in assayable desmopressin was found in breast milk. See Table 1 for volume of diluent to use. Your doctor may adjust the dose as needed. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Celecoxib; Tramadol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Consider other treatment options for this condition. A woman who took both desmopressin and ibuprofen was found in a comatose state. IV injection due to hypotension, bradycardia, and arrhythmias. Meclofenamate Sodium: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. However, dose should always be titrated individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) of the patient. This site needs JavaScript to work properly. Indications: Hemophilia (increases factor VIII levels): 0.3 mcg/kg in 50ml normal saline over 15-30 minutes. administer single spray (150 mcg) if patient >12 years of age but <50 kg body weight. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Inject subcutaneously taking care not to inject intradermally. 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. It is chemically defined as follows: Mol. 1 spray (150 mcg) per nostril (300 mcg total dose) if >12 years of age or >50 kg body weight. 1 to 2 mcg subcutaneously twice a day or If 30 mcg is divided, typically 20 mcg is given in the morning, and 10 mcg is given at night. They should also avoid drinks containing caffeine and alcohol before bedtime. 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. Intranasal: 5 mcg/day as a single dose or in 2 divided doses. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia. Budesonide; Glycopyrrolate; Formoterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Cortisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 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. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Bupivacaine; Meloxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. A woman who took both desmopressin and ibuprofen was found in a comatose state. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. xTMk1?DFh!PiHhmz(=lk;p"v< Fobt7t?@IFT];XaYV={~w ^JLAIIG\G\m$XJe@xH8!ZDhrN*'VH4'J.cq 'A%;v}q+i+&L 44qDxR)o3 Beclomethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Acetaminophen; 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. Serum concentrations of potassium, sodium, and creatinine do not change following the administration of desmopressin, and urinary excretion of potassium and sodium also remains the same. In hemophilia A and von Willebrand disease, it should only be used for mild to moderate cases. In additio 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. The mechanism of action of desmopressin in IV: 0.3 mcg/kg once slowly over 15 to 30 minutes. Desmopressin is a man-made form of vasopressin and is used to replace a low level of vasopressin. The following pharmacist will check on these open i-Vents and close then when appropriate. A woman who took both desmopressin and ibuprofen was found in a comatose state. 150 mcg into 1 nostril once for a total dose of 150 mcg. Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Desmopressin has been used safely in many women during pregnancy, including those with bleeding disorders and diabetes insipidus. Infants 3 months of age and children: The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia 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. About 1/4 to 1/3 of patients can be controlled by a single daily dose. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours. Repeat administration should be determined by laboratory response and clinical condition of the patient. In a male subject with mild Von Willebrand (vW) disease, intravenous infusion of DDAVP 2 hours after administration of oral tolvaptan did not produce the expected increases in vW Factor Antigen or Factor VIII activity. Use careful attention to fluid management to avoid hyponatremia in the peripartum and postpartum period and weigh the possible therapeutic advantages against the possible risks in each individual case. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. DDAVP Nasal SprayDDAVP nasal spray delivers doses in 0.1 mL (10 mcg) increments. Levels of FVIII are also increased, which increases hemostasis by accelerating fibrin formation. Maximal dose-response increase in Factor VIII activity occurs at 0.3 to 0.4 mcg/kg desmopressin. Cisplatin: (Moderate) Frequently monitor serum sodium levels if concurrent use of desmopressin and cisplatin is necessary. Preoperative doses may be given 2 hours prior to the scheduled procedure. Adjust dose based upon response to treatment estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. 2022 Mar 8;7(1):e000852. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. According to the Beers Criteria, desmopressin is considered a potentially inappropriate medication (PIM) in geriatric adults and avoidance is recommended for treating nocturia or nocturnal polyuria because there is a high risk of hyponatremia and safer alternatives are available. Conversion of IV Midazolam. Oral doses of 0.2 and 0.4 mg produce similar responses on urine volume and urine osmolality as 0.01 mg and 0.02 mg intranasal doses. The pharmacist leaving the sticky not will open and IV to po i-Vent, leave this i-Vent open until the medication is changed. If Desmopressin Acetate Injection 4 mcg/mL is used preoperatively, it should be administered 30 minutes prior to the scheduled procedure. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Chlorpromazine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including chlorpromazine. Caution should be used when coadministering these agents. Loop diuretics: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. Torsemide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. Unlike nearly all other benzodiazepine conversions, the conversion between intravenous midazolam and lorazepam has been well studied in mechanically ventilated patients. Only start or resume therapy in patients with a normal serum sodium concentration. If used to reduce spontaneous or traumatic bleeding, doses may be repeated after 8 hours to 12 hours and once daily thereafter, if needed, based upon clinical condition and von Willebrand factor and factor VIII levels. Bioavailability and pharmacokinetics of desmopressin in elderly men. Background. Triamterene; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Wirtz MR, Roelofs JJ, Goslings JC, Juffermans NP. Desmoperssin is the drug of choice for treatment of central diabetes insipidus and most commonly it is used as intranasal spray. Vasopressin, ADH: (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 vasopressin, ADH only with careful patient monitoring. Desmopressin is a synthetic analog of vasopressin used to reduce renal excretion of water in central diabetes insipidus and nocturia. 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. 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. Desmopressin iv to po conversion Common Questions and Answers about Desmopressin iv to po conversion ddavp My father had a brain tumor removed and now has to take a nasal spray called Desmopressin. The necessity for repeat administration of desmopressin acetate or use of any blood products for hemostasis should be determined by laboratory response as well as the clinical condition of the patient.