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Stimate® / DDAVP challenge

 

What is Stimate / DDAVP?

DDAVP is a medicine that we can use to help stop bleeding in patients with von Willebrand disease and sometimes for patients with mild or moderate Hemophilia A. We can either give it IV (in a vein) or in the nose. Stimate is the nasal spray that contains the drug desmopressin acetate and provides 150 mcg per spray (1.5mg/mL).

How does it work?

Von Willebrand factor (VWF) is a protein in your blood that acts like glue with your body’s platelets to help your blood form a clot to stop bleeding. Some patients with von Willebrand disease do not have enough VWF. Other patients have enough VWF, but it does not work properly. VWF is stored in the platelets of the blood and in cells that line the blood vessels.

Stimate helps to release VWF from where it is being stored, so that it is ready to be used in the body to stop the bleeding. It is like when you store toys in the closet until your child is ready to use them. Stimate® opens the doors to the closet (platelets) to take out a toy (VWF) so it can be used.

What is a DDAVP / Stimate Challenge and why do we need to do one?

DDAVP/Stimate® may not work for everyone. We do a “Stimate Challenge” to make sure it will help your child stop bleeding. If it works, you can use it before your child has dental work or minor surgeries, and for some bleeding episodes. However, always talk to your hematologist (blood disorder doctor) before your child has any procedure that involves cutting the skin.

What should we expect during a DDAVP / Stimate Challenge?

A DDAVP/Stimate Challenge will be done in the Medicine Room of the St. Jude Children’s Research Hospital Patient Care Center.

A nurse will take a sample of your child’s blood using a small needle. It will be sent to the lab to check for VWF antigen and activity levels, a factor VIII level and a platelet count. An IV may need to stay in place until all labs are verified as good quality.

DDAVP comes as either a medication that is given in an IV or as a nasal spray (Stimate.) If your child is using the nasal form, your child should blow her nose first then “sniff” the medicine up her nose. Patients who weigh less than 110 pounds (50 kg) will get one (1) spray (150 mcg) into the nose. Patients who weigh more than 110 pounds (50 kg) will get 2 sprays (150 mcg each); that is one (1) spray in each nostril.

After your child gets the IV DDAVP or inhales the nose spray, you will wait about 60 minutes. Then, the nurse will take another blood sample to check the same blood levels. Sometimes the nurse will use the IV. Other times, a new sample is needed with a fresh needle stick. In some cases, a third blood sample will be collected 4 hours after the medicine is given. These blood samples will be sent to a lab outside St. Jude. Our hope is that the DDAVP/Stimate made the levels of VWF and Factor VIII in your blood increase. A hematology staff member will call you with the results in about 1–2 weeks.

You will be allowed to take home the remaining bottle of Stimate if the nasal spray is used, but do not let your child use it until you hear from the hematology team.

What results should we expect?

Three possible results can come from a DDAVP/Stimate Challenge:

  • The DDAVP/Stimate did not increase the levels of VWF and Factor VIII, which means it will not help stop bleeding in your child and cannot be used.
  • The DDAVP/Stimate caused an increase in the VWF levels and Factor VIII. If this happens, the doctor will call you and tell you how your child should use Stimate for bleeding or to prevent bleeding.
  • DDAVP/Stimate may not raise the levels enough for surgeries or life-threatening bleeding, but it can be used for minor bleeding.

Questions?

If you have further questions about von Willebrand disease, Hemophilia A, DDAVP, Stimate or having a DDAVP/Stimate Challenge, talk to your child’s hematology team.


 

This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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