Why should a Stimate® test dose be administered?
A. Stimate® Nasal Spray is approved for use in patients who have mild hemophilia A or mild to moderate type 1 von Willebrand disease. Not all patients will respond therapeutically to Stimate®; therefore, a test dose should be administered to the patient under controlled conditions such as in the office. Blood specimens should be obtained from the patient before the test dose is given and approximately 90 to 120 minutes after administration of the test dose. The usual adult dose is one spray in each nostril, for a total dose of 300 mcg. In patients weighing less than 50 kg, a single spray dose of 150 mcg should be given. Recommended laboratory tests to assess response include Factor VIII:C, VWF:Ag, and VWF:RCo, all compared to predosing baseline values. A positive responder to the Stimate® test dose should have approximately a two- to four-fold rise in the levels of factor VIII activity, von Willebrand antigen, and ristocetin cofactor activity. The physician should feel that adequate le
