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

We report our experience with the incidence of adverse events during the us e of Stimate(R) brand intranasal desmopressin acetate (IN DDAVP) for patien ts 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, mo derate or symptomatic carrier) from the Emery Comprehensive Hemophilia Cent er who had IN DDAVP challenge testing or were using Stimate(R) for treatmen t of bleeding were evaluated for adverse events by patient report or nursin g observation of clinical signs and symptoms. Forty patients were studied. Sixty-eight per cent (27/40) experienced clini cal signs and/or symptoms. The majority of these symptoms were mild, howeve r several patients reported moderate to severe side-effects and one adult p atient 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(R); considerably higher than that r eported from preliminary results in the literature. Young age did not corre late positively with adverse reactions. Severe adverse events requiring med ical intervention were rare, however symptoms such as moderate to severe he adache, nausea, vomiting and weakness may necessitate evaluation for hypona traemia. This is the first report of symptomatic hyponatraemia in an adult patient sith recommended dosing of Stimate(R). Side-effects may be minimize d if patients adhere to instructions regarding fluid intake and composition while using IN DDAVP.