| Administration | Caveats and comments |
| Uses and limitations | - Adequate response to a test dose is ideally established before use, but a patient with AVWS and acute bleeding may receive the first dose as a therapeutic trial
- Do not use in children <2 years of age
- Avoid or use with extreme care in individuals with cardiovascular disease
- Avoid or use with extreme care in pregnant women
|
| Dosing | - May be repeated once daily for 3 to 5 days. Beyond 5 days, tachyphylaxis renders it ineffective
|
| Intravenous or subcutaneous | - Intravenous: 0.3 mcg/kg (maximum 20 mcg) diluted in 50 mL of normal saline and infused over 20 to 30 minutes
- Subcutaneous (not approved for use in the United States): 0.3 mcg/kg (maximum 20 mcg) subcutaneously
|
| Nasal spray | - Use the formulation intended for hemostasis (concentration of 1.5 mg/mL; dose 150 mcg/spray), not the formulation for enuresis (concentration of 0.01%)
- Weight <50 kg: One spray in one nostril (total dose 150 mcg)
- Weight ≥50 kg: One spray in each nostril (total dose 300 mcg)
|
| Adverse events |
| Hyponatremia | - Avoid excess free water intake (oral or intravenous)
- Avoid NSAIDs
- Monitor serum sodium
|
| Thrombotic events | - Especially of concern in individuals with pre-existing increased risk factors such as cardiovascular disease
|
| Headache, flushing, hypotension, hypertension | - Usually alleviated by slowing the infusion
|
