deamino-arginine-vasopressin and Fatigue

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.

Topics: Administration, Intranasal; Adolescent; Adult; Age Factors; Child; Child, Preschool; Deamino Arginine Vasopressin; Fatigue; Female; Headache; Hemophilia A; Hemostatics; Heterozygote; Humans; Hyponatremia; Male; Menorrhagia; Middle Aged; Nausea; Potassium; Sex Factors; Sodium; von Willebrand Diseases; Weight Gain

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus; Fatigue; Female; Glucocorticoids; Humans; Hypopituitarism; Hypotension; Middle Aged; Radiotherapy; Syncope

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Fatigue; Female; Fluid Therapy; Humans; Hyponatremia; Munchausen Syndrome; Treatment Outcome

Intravenous administration of 0.4 micrograms DDAVP/kg body weight in 16 normal controls, 34 patients with haemophilia A and 30 patients with von Willebrand's disease (vWd) was followed by an increase in FVIII: C from 230 to 410%, in FVIIIR:Ag from 160 to 260% and FVIIIR:RC of from 160 to 320%. Additionally, in the patients with vWd, a shortening of the bleeding time and improvement in platelet retention was observed. In 7 haemophiliacs with pretreatment levels of FVIII: C ranging from between 11 and 43% dental extractions were performed successfully after DDAVP whereas in 2 patients with FVIII: C levels of 5 and 6%, respectively, severe bleeding necessitated administration of factor VIII concentrates. In 8 haemophiliacs (FVIII: C between 6.5 and 50%) and 2 patients with vWd (FVIII: C 18 and 36%, respectively) DDAVP enabled minor surgery and successful therapy of spontaneous or traumatic bleeding complications. However, severe postoperative bleeding after stomach surgery in 2 haemophiliacs (FVIII: C 23 and 40%, respectively) and severe menstrual bleeding in one patient with vWd (FVIII: C 15%) required administration of factor VIII concentrates. At present DDAVP therapy should be restricted to minor surgery and non-life-threatening, spontaneous or traumatic bleeding complications in patients with pretreatment FVIII: C levels higher than 10%.

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Factor VIII; Fatigue; Flushing; Hemophilia A; Hemorrhage; Humans; Hypertension; Surgical Procedures, Operative; Tooth Extraction; von Willebrand Diseases