DOCA
Clinical safety rating: caution
Comprehensive 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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DOCA (DOCA).
| Breastfeeding | Excreted in breast milk in low amounts; M/P ratio not established. Potential for adverse effects in nursing infants (e.g., electrolyte disturbances, hypertension). Use caution; consider alternative therapies. |
| 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. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to desoxycorticosterone or any component","Severe renal impairment","Hyperkalemia","Hypocalcemia","Congestive heart failure","Systemic fungal infections"]
| Precautions | ["Fluid overload and edema","Hypokalemia","Hypertension","Cardiac hypertrophy and failure","Increased risk of infection due to immune suppression when used with glucocorticoids"] |
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| 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. |