BNF for Children 2011-2012

386 6.5.2 Posterior pituitary hormones and antagonists BNFC 2011–20126 Endocrine systemPregnancy small oxytocic effect in third trimester;increased risk of pre-eclampsiaBreast-feeding amount too small to be harmfulSide-effects fluid retention, and hyponatraemia (inmore serious cases with convulsions) on administrationwithout restricting fluid intake; stomach pain,headache, nausea, vomiting, allergic reactions, andemotional disturbance in children also reported;epistaxis, nasal congestion, rhinitis with nasal sprayLicensed use consult product literature for individualpreparations; not licensed for assessment ofantidiuretic hormone secretionIndication and doseAssessment of antidiuretic hormone secretion(congenital deficiency suspected) (specialist useonly). IntranasallyChild 1 month–2 years initially 100–500 nanogramsas a single doseAssessment of antidiuretic hormone secretion(congenital deficiency not suspected) (specialistuse only). IntranasallyChild 1 month–2 years 1–5 micrograms as asingle doseTest for suspected diabetes insipidus (waterdeprivation test). IntranasallyNeonate not recommended, use trial of treatmentChild 1 month–2 years 5–10 micrograms as asingle dose; not usually recommended, see notesaboveChild 2–12 years 10–20 micrograms as a singledose, see notes aboveChild 12–18 years 20 micrograms as a singledose, see notes above. By subcutaneous or intramuscular injectionNeonate not recommended, use trial of treatmentChild 1 month–2 years 400 nanograms as a singledose; not usually recommended, see notesaboveChild 2–12 years 0.5–1 microgram as a singledose, see notes aboveChild 12–18 years 1–2 micrograms as a singledose, see notes aboveDiabetes insipidus, treatment. By mouth(as desmopressin acetate)Neonate initially 1–4 micrograms 2–3 times daily,adjusted according to responseChild 1 month–2 years initially 10 micrograms 2–3 times daily, adjusted according to response(range 30-150 micrograms daily)Child 2–12 years initially 50 micrograms 2–3times daily, adjusted according to response (range100-800 micrograms daily)Child 12–18 years initially 100 micrograms 2–3times daily, adjusted according to response (range0.2–1.2 mg daily). Sublingually(as desmopressin base)Child 2–18 years initially 60 micrograms 3 timesdaily, adjusted according to response (range 40–240 micrograms 3 times daily). Intranasally(as desmopressin acetate)Neonate initially 100–500 nanograms, adjustedaccording to response (range 1.25–10 microgramsdaily in 1–2 divided doses)Child 1 month–2 years initially 2.5–5 micrograms1–2 times daily, adjusted according to responseChild 2–12 years initially 5–20 micrograms 1–2times daily, adjusted according to responseChild 12–18 years initially 10–20 micrograms 1–2times daily, adjusted according to response. By subcutaneous or intramuscular injectionNeonate initially 100 nanograms once daily,adjusted according to response (intramuscularroute only)Child 1 month–12 years initially 400 nanogramsonce daily, adjusted according to responseChild 12–18 years initially 1–4 micrograms oncedaily, adjusted according to responsePrimary nocturnal enuresis. By mouth(as desmopressin acetate)Child 5–18 years 200 micrograms at bedtime,increased to 400 micrograms at bedtime only iflower dose not effective (important: see alsoCautions), reassess after 3 months by withdrawingtreatment for at least 1 week. Sublingually(as desmopressin base)Child 5–18 years 120 micrograms at bedtime,increased to 240 micrograms at bedtime only iflower dose not effective (important: see alsoCautions); reassess after 3 months by withdrawingtreatment for at least 1 weekFibrinolytic response testing. By intravenous injection over 20 minutes or bysubcutaneous injectionChild 2–18 years 300 nanograms/kg as a singledose; blood sampled after 20 minutes for fibrinolyticactivityMild to moderate haemophilia and von Willebrand’sdisease. By intravenous infusion over 20 minutes or bysubcutaneous injectionChild 1 month–18 years 300 nanograms/kg as asingle dose immediately before surgery or aftertrauma; may be repeated at intervals of 12 hours ifno tachycardia