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After at least 7 days of treatment, the dose may be increased to 1.66 mcg, if needed, provided the serum sodium is within the normal range during treatment with the 0.83 mcg dose. Oral to IV Conversion: The intravenous dose of levothyroxine is not the same as the oral dose. See Table 1 for volume of diluent to use. Step-down therapy: changing to an oral drug that is a different compound and has different frequency, dose, or spectrum of activity. 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). Prepare the solution for infusion using aseptic technique. I don't know why you would suddenly notice a decrease in your symptoms after 34 years. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Fenoprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Budesonide; Glycopyrrolate; Formoterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Acetaminophen; 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. Intermittent intravenous infusionFor adults and children weighing greater than 10 kg, dilute dose in 50 mL of 0.9% Sodium Chloride for injection. Desmopressin Intranasal (Noctiva, low dose) Each spray delivers 0.83 to 1.66 mcg Marketed for Nocturia in adults (but other non-medication approaches are preferred) Expensive: $425/month in 2018 Desmopressin Oral Initial: 0.2 mg PO qhs Use lowest effective dose Increase as needed to 0.6 mg at bedtime VII. Determine need for repeat dosage based on laboratory response and patient's clinical condition. About 1/4 to 1/3 of patients can be controlled by a single daily dose. 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. If there are dry nights after Desmopressin is used, continue using it for 3 months and then review your child's progress. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. If there is no response, the medication will be stopped. A woman who took both desmopressin and ibuprofen was found in a comatose state. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 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. desmopressin iv to po conversion Desmopressin acetate injection is administered as an intravenous infusion at a dose of 0.3 mcg desmopressin acetate/kg body weight diluted in sterile physiological saline and infused slowly over 15 to 30 minutes. wt. Fluticasone; Umeclidinium; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Nonsteroidal antiinflammatory drugs: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. It is not known if the drug is metabolized; however, in contrast to vasopressin, desmopressin does not appear to be degraded by the peptidase enzymes responsible for metabolizing endogenous vasopressin during the last trimester of pregnancy. Deflazacort: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. The pump will stay primed for up to 1 week. A woman who took both desmopressin and ibuprofen was found in a comatose state. Interrupt therapy for acute illness (e.g., systemic infection, fever, recurrent vomiting or diarrhea), extremely hot weather, vigorous exercise, or other conditions associated with increased water intake. Carbinoxamine; 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. Increased FVIII and vWF levels are thought to be due to their release from endogenous reservoirs and not increased synthesis since the response is so rapid. Fluticasone; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. 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. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Meloxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. The risk of toxic reactions (including water intoxication and low sodium concentrations) appears to be greater in the geriatric patient and other patients with impaired renal function. 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. Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb. Dose should be reduced. Preoperative IV doses may be given 30 minutes prior to scheduled procedure. Paediatr Drugs. The bioavailability was 0.08%. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Keep this seal as it is reversed to prevent leakage from the dropper.Squeeze the correct dose into this tube from the dropper bottle. Initiate at low dose and increase as necessary. Most patients respond to 1 to 2 doses; administer a second dose 8 to 24 hours after the first dose if needed. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 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. Administration of intranasal desmopressin may be compromised by nasal mucosa changes (e.g., nasal trauma, nasal surgery, nasal blockage, nasal mucosal atrophy, congestion, or severe atrophic rhinitis), cranial surgery, and nasal packing. Doses may be titrated up to 0.6 mg PO once daily at bedtime, depending on individual patient response. To investigate (1) the pharmacokinetic and pharmacodynamic profiles of desmopressin in men from an age group with a high incidence of nocturia; and (2) circadian variation in the pharmacokinetic parameters. May repeat dose if needed. Desmopressin is contraindicated in patients with moderate to severe renal impairment (e.g., CrCl less than 50 mL/minute or eGFR less than 50 mL/minute/1.73 m2). Oral TabletsIf converting from intranasal therapy, administer oral dose 12 hours after last intranasal dose.Patient response to each dose should be determined by adequate duration of sleep and adequate, not excessive, water turnover. x}n y)Zn91Iv l38Y8bIkYbX$=x:9\>?}st_~xOo^\~dt&&=\~o~g/}~y%;]V|s{h+j/~\f'iqriwZgI~IOk[b,n6'K+%Y{Y?k{]U4{H}mWRa |3}ktz_>iCy>VbZ{SZ(_!> _~{pz.5'Kxo'wW0P*okGa? 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. Plasminogen activator activity increases after intravenous desmopressin, but clinically significant fibrinolysis has not been detected in patients treated with desmopressin. Desmopressin is also used to control bed-wetting. Prior to treatment with DDAVP, assess serum sodium, urine volume and osmolality. . The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Diphenhydramine; 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. 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. There is no increase in activity with doses greater than 0.4 mcg/kg, despite increases in desmopressin concentrations. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. Children more than 12 years of age: Initially, 0.2 mg PO once daily at bedtime. dose conversion. 4 0 obj DDAVP (Desmopressin Acetate Tablets) may treat, side effects, dosage, drug interactions, warnings, patient labeling, reviews, and related medications including drug comparison and health resources. *L#n~i V3{kf_t.wjO_KgImL%4+GJ+Pp QsWAd._e7p!90&z {c`Kk;swZ/Nf{s~d? C. The pharmacist must enter Epic order comments stating "IV to PO Conversion per P&T policy for all interchanged orders. % Which lab value should prompt the nurse to question a medication dosage increase? The effect of DDAVP was measured on F VIII/vWF complex and on plasminogen activator release. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Ibuprofen; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Proposed sites of these receptors include endothelial cells, megakaryocytes, blood monocytes, and mast cells. Blood pressure and heart rate monitoring during infusion is recommended. Nabumetone: (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. 2022 Mar 21;13:840971. doi: 10.3389/fendo.2022.840971. This is probably due to saturation of receptor sites. Tricyclic antidepressants: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hydrocodone; Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Acetaminophen; Chlorpheniramine; Dextromethorphan; 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. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Intranasal: 1 spray (1.5 mg/mL) in each nostril one time. Use this combination with caution, and monitor patients for signs and symptoms of hyponatremia. Fluid restrictions should be observed. Rapid IV bolus 4. Repeat administration should be determined by laboratory response as well as the clinical condition of the patient. A woman who took both desmopressin and ibuprofen was found in a comatose state. IN 1977 DESMOPRESSIN (1-deamino-8-D-arginine vasopressin, abbreviated DDAVP), a derivative of the antidiuretic hormone, was used for the first time to treat patients with hemophilia A and von Willebrand disease (vWD), the most frequent congenital bleeding disorders. Last updated on Apr 7, 2022. DDAVP (2 micrograms IV q8hr) is started immediately and continued until the sodium is close to normal. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Consider risk vs. benefit as pregnant women with Hemophilia A or von Willebrand's disease as these patients may be at an increased risk for bleeding diatheses and hemorrhagic events at delivery; affected neonates may also be at risk of bleeding diatheses. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. 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. 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. Ensure that serum sodium is normal prior to initiating or resuming treatment with DDAVP Injection. more than 50 kg: 150 mcg in each nostril. Objective: To investigate (1) the pharmacokinetic and pharmacodynamic profiles of desmopressin in men from an age group with a high incidence of nocturia; and (2) circadian variation in the pharmacokinetic parameters. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 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. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Desmopressin was administered orally (0.2 mg) and intravenously (2 microg), daytime and night-time, yielding four in-hospital sessions, separated by at least 2 days. Prednisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Medically reviewed by Drugs.com. Initially, 0.2 mg PO once daily at bedtime. [42295], 2 to 4 mcg IV or subcutaneously given in 1 or 2 divided doses daily. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. The site is secure. For the treatment of hypothyroidism of any etiology, except during the recovery phase of subacute thyroiditis; used as a replacement in primary (thyroidal), secondary (pituitary), tertiary (hypothalamic), congenital (cretinism), or acquired hypothyroidism. 27.7 mcg sublingually once daily, 1 hour before bedtime without water. A woman who took both desmopressin and ibuprofen was found in a comatose state. Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Limit fluid intake to a minimum 1 hour before and 8 hours after administration. In certain clinical situations, it may be justified to try desmopressin in persons with factor VIII concentrations of 2% to 5%; however, carefully monitor these patients. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia. Chronic desmopressin administration may result in changes to nasal mucosa (scarring and edema), which may cause erratic and unreliable absorption. To prime, press down 4 times. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Bookshelf Response should be estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. Renal concentration capacity testing in children below the age of 1 year should only be performed under carefully supervised conditions in hospital. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Then i-Vents acuity will now have a 10 to signify there is a open i-Vent. 1995 Apr;42(4):373-8. doi: 10.1111/j.1365-2265.1995.tb02645.x [ PubMed ] 10646654 Yamamoto T, Fukuyama J, Fujiyoshi A. 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. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Fluticasone; Salmeterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Initially, 0.05 mg PO once daily. Peak plasma concentration (Cmax) was 6.2 (5.1-7.5) pg/ml at night and 6.6 (5.5-7.9) pg/ml in the daytime. Carbetapentane; 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. The concentration-time curve after 2 microg intravenous desmopressin was best described using a biexponential term. All Rights Reserved. -, Br J Urol. THOSE AT INCREASED RISK FOR HYPONATREMIA: 1 spray (0.83 mcg) in either the left or right nostril approximately 30 minutes before going to bed. Etodolac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Bupivacaine; Meloxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Trauma Surg Acute Care Open. Desmopressin is a strong V2 agonist and has no effect on V1 receptors. The usual dosage range is 0.1 mg to 1.2 mg PO per day, given in 2 to 3 divided doses. Desmopressin is administered orally, intranasally, or parenterally (intravenous or subcutaneously). SOLU CORTEF IV TO PO CONVERSION - CHRISTIANTUTTL2'S BLOG. If used preoperatively, administer 2 hours before surgery. 4 0 obj However, dose should always be titrated individually according to the diuresis (antidiuretic response) and electrolyte status (serum sodium) of the patient. Preoperative doses may be given 2 hours prior to the scheduled procedure. 1. What is the standard conversion technique to calculate those dosages from a typical. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. When administered to patients with central diabetes insipidus, desmopressin exerts antidiuretic effects similar to those of vasopressin; a reduction in urine output with an accompanying increase in urine osmolality and a decrease in clinical symptoms of urinary frequency and nocturia are noted following desmopressin treatment. In patients receiving desmopressin nasal spray for nocturia, discontinue treatment in patients with concurrent nasal conditions that may increase systemic absorption of desmopressin (e.g., atrophy of nasal mucosa, and acute or chronic rhinitis), because the increased absorption may increase the risk of hyponatremia. For a patient requiring volume resuscitation, a large volume of normal saline could be . Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Flunisolide: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Persons with vWD subtype 1C, which is characterized by a shorted vWF half-life, may require alternative management in the setting of surgery. However, desmopressin is used off-label as a single injection for uremic bleeding in persons with renal failure. Betamethasone: (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; Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Desmopressin is administered intravenously or subcutaneously.Desmopressin (DDAVP) injection has an antidiuretic hormone activity of 16 International Units/mL; 1 mcg desmopressin is equivalent to 4 International Units antidiuretic hormone activity.If given preoperatively, desmopressin injection should be given 30 minutes before the scheduled procedure.Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. -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. 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. Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. On Day 7, 6 subjects were given a single SC bolus injection of desmopressin. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Response should be estimated by 2 parameters, adequate duration of sleep and adequate, not excessive, water turnover. A woman who took both desmopressin and ibuprofen was found in a comatose state. Also known as antidiuretic hormone (ADH), vasopressin is secreted by the hypothalamus in response to hyperosmolarity, volume depletion, stress (emotional or physiological), certain drugs, and painful stimuli. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Subcutaneously: 1 to 2 mcg twice a day Initially, 0.05 mg PO twice daily, then titrate to response. The resultant increases in FVIII and vWF are similar to those seen with replacement therapy using blood products. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Desmopressin has slight structural variations that reduce its affinity for V1 receptors and lessen its vasopressin activity and contractile action on visceral smooth muscle. You may require 10 to 20 times a greater dose of desmopressin with the tablet oral formulations than with the nasal formulations. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. 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. HOW SUPPLIED Desmopressin Acetate Injection 4 mcg/mL is available as a clear colorless sterile solution as follows: Ampul - 4 mcg/mL - 1 mL - 10 per Box. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA. Celecoxib: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. When desmopressin is administered to patients who do not have need of antidiuretic hormone for its antidiuretic effect, in particular pediatric and geriatric patients, fluid intake should be adjusted downward to decrease to potential occurrence of water intoxication and hyponatremia with accompanying signs and symptoms (headache, nausea/vomiting, decreased serum sodium and weight gain). The .gov means its official. 3 0 obj Generic Name. If patient responded to 20 mcg/day, the dose was adjusted downward to 10 mcg/day to see if response could be maintained. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Diclofenac; Misoprostol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. During treatment with DDAVP Injection, assess serum sodium, bleeding time, factor VIII coagulant activity, ristocetin cofactor activity, and von Willebrand antigen to ensure that adequate levels are being achieved. > = 12 years and adult: 2-4 mcg/day IV/SC divided BID or 1/10 of the . The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced. Dextromethorphan; 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. Patients receiving intranasal treatment could begin oral therapy the night following (24 hours) the last intranasal dose. A woman who took both desmopressin and ibuprofen was found in a comatose state. Desmopressin (dDAVP), a synthetic analogue of 8-arginine vasopressin (ADH), is an antidiuretic . Tolvaptan is a V2 receptor antagonist and may interfere with the V2 agonist activity of DDAVP.