DOCA
Clinical safety rating
cautionComprehensive clinical and safety monograph for DOCA (DOCA).
Desoxycorticosterone acetate (DOCA) is a mineralocorticoid hormone that binds to mineralocorticoid receptors in the distal renal tubules, promoting sodium reabsorption and potassium excretion, leading to increased extracellular fluid volume and blood pressure.
| Metabolism | Primarily hepatic metabolism via reduction and conjugation; little is known about specific CYP enzymes. |
| Excretion | Primarily renal as metabolites; <5% unchanged. Biliary/fecal elimination is negligible (<2%). |
| Half-life | 30-35 minutes; clinical context: short duration necessitates frequent dosing or continuous infusion for sustained effect. |
| Protein binding | ~70% bound to plasma proteins (primarily albumin). |
| Volume of Distribution | Vd: 0.8-1.2 L/kg; indicates extensive tissue distribution with rapid redistribution from effect sites. |
| Bioavailability | Oral: <5% due to extensive first-pass metabolism; IM/SC: 100%. |
| Onset of Action | IV: <1 minute; IM: 2-5 minutes; Subcutaneous: 3-5 minutes. |
| Duration of Action | IV: 10-20 minutes; IM/SC: 20-40 minutes. Clinical context: rapid offset limits use for prolonged procedures. |
| Molecular Weight | 414.63 |
Desoxycorticosterone acetate (DOCA) is administered intramuscularly at a dose of 2 to 5 mg daily or 10 mg every 12 hours initially, then reduced to 1 to 2 mg daily or every other day for maintenance. Alternatively, a pellet implant of 125 mg or 250 mg can be used for prolonged effect.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment is recommended for impaired renal function, but monitor for fluid retention and hypertension. Use with caution in patients with significant renal impairment. |
| Liver impairment | No specific dose adjustment for hepatic impairment, but use with caution due to potential electrolyte disturbances. |
| Pediatric use | Dose is not well established; use 0.1 to 0.2 mg/kg intramuscularly daily or adjust based on clinical response and serum electrolytes. |
| Geriatric use | Start at the lower end of the dosing range (e.g., 1 to 2 mg IM daily) and monitor closely for fluid overload, hypertension, and electrolyte imbalances due to age-related decreased renal function and comorbidities. |
| 1st trimester | Associated with fetal virilization and other androgenic effects; contraindicated in pregnancy. |
| 2nd trimester | Associated with fetal virilization and other androgenic effects; contraindicated in pregnancy. |
| 3rd trimester | Associated with fetal virilization and other androgenic effects; contraindicated in pregnancy. |
Clinical note
Comprehensive clinical and safety monograph for DOCA (DOCA).
| Placental transfer | Crosses the placenta and can cause virilization of female fetuses. |
| Breastfeeding | Excreted into breast milk; may cause androgenic effects in the infant. Use is not recommended during breastfeeding. |
| Lactation Rating | L5 - Contraindicated |
| Teratogenic Risk | FDA Pregnancy Category C. First trimester: feminization of male fetuses, including hypospadias and clitoral hypertrophy, due to androgenic activity. Second and third trimesters: risk of virilization of female fetuses; no adequate human studies; avoid use unless potential benefit outweighs risk. |
| Fetal Monitoring | Monitor maternal blood pressure, serum electrolytes (sodium, potassium), and fluid status regularly. Assess fetal growth and amniotic fluid volume via ultrasound due to potential for fluid retention and hypertension. |
| Fertility Effects | May impair spermatogenesis in males and disrupt menstrual cycle in females due to hormonal effects; reversible upon discontinuation. |
■ FDA Black Box Warning
None
| Serious Effects |
PregnancyHypertensionHeart failureHepatic impairmentRenal insufficiencyHypercalcemiaHypersensitivity to desoxycorticosterone or any component
| Precautions | Fluid overload and edema, Hypokalemia, Hypertension, Cardiac hypertrophy and failure, Increased risk of infection due to immune suppression when used with glucocorticoids |
| Food/Dietary | No specific food interactions are reported. However, maintain consistent sodium intake; do not restrict salt unless advised. Avoid potassium-rich foods if potassium levels are high. Alcohol may increase the risk of electrolyte disturbances. |
| Clinical Pearls | DOCA (desoxycorticosterone acetate) is a mineralocorticoid used in adrenal insufficiency. Monitor serum potassium closely due to risk of hypokalemia from excessive mineralocorticoid activity. DOCA requires intramuscular injection; do not administer intravenously. Use in conjunction with glucocorticoids to mimic cortisol's permissive effects on catecholamines. Avoid in patients with hypertension, heart failure, or renal impairment due to sodium and water retention. |
| Patient Advice | This medication helps maintain salt and water balance in the body. · It is given as an injection into a muscle; do not inject into a vein. · Report signs of excessive fluid retention: swelling in legs, rapid weight gain, shortness of breath. · Monitor for muscle cramps or weakness which may indicate low potassium levels. · Avoid salt substitutes containing potassium without consulting your doctor. · Do not miss appointments for injections as consistent dosing is critical. · Carry medical identification indicating you take corticosteroid replacement therapy. |
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