BMA Concise Guide to Medicine & Drugs

Desmopressin

Brand names DDAVP, DesmoMelt, Desmospray, Desmotabs, Nocutil, Octim

Used in the following combined preparations None

QUICK REFERENCE

Drug group Drug for diabetes insipidus

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Desmopressin is a synthetic form of the hormone vasopressin. Low levels of vasopressin in the body can lead to diabetes insipidus, which causes excess urine production and continual thirst.

Desmopressin can be used to correct the deficiency of vasopressin. It is also used to test for diabetes insipidus, to check kidney function, and to treat nocturnal enuresis (bedwetting) in both children and adults. When given by injection, it helps to boost clotting factors in haemophilia and von Willebrand’s disease.

Side effects include low blood sodium and fluid retention (which sometimes requires monitoring of body weight and blood pressure to check the body’s water balance). Desmopressin should not be taken during an episode of vomiting and diarrhoea because the body’s fluid balance may be upset.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor

How taken/used Tablets, injection, nasal solution, nasal spray.

Frequency and timing of doses Diabetes insipidus 3 x daily (tablets); 1–2 x daily (nasal spray/solution). Nocturnal enuresis At bedtime (tablets, nasal spray/solution). Avoid fluids from 1 hour before bedtime to 8 hours afterwards.

Dosage range Diabetes insipidus: Adults 300–600mcg daily (tablets); 1–4 puffs (nasal spray); 10–40mcg daily (nasal solution). Children 300–600mcg daily (tablets); up to 2 puffs (nasal spray); 20mcg (nasal solution). Nocturnal enuresis: 200–400mcg for adults and children over 5 years only (tablets); 20–40mcg (nasal solution); 2–4 puffs (nasal spray).

Onset of effect A few minutes: full effects, a few hours (injection, nasal solution/spray); 30–90 minutes (tablets).

Duration of action Tablets 6–12 hours; injection, nasal solutions, and nasal spray 5–21 hours.

Diet advice Your doctor may advise you to avoid excessive fluid intake.

Storage Keep in original container at room temperature (tablets) or in a refrigerator, without freezing (nasal solution and nasal spray), out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms of diabetes insipidus may recur.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may prevent the kidneys from eliminating fluid, with ensuing problems including seizures. Notify your doctor immediately.

POSSIBLE ADVERSE EFFECTS

Adverse effects with desmopressin are uncommon. However, it may cause fluid retention (which may cause weight gain) and low blood sodium, especially if fluid intake is too high. In serious cases, this can lead to seizures; if so, stop taking the drug and contact your doctor immediately. Headache, nausea, vomiting, nasal congestion, and nosebleeds may also occur; if these symptoms are severe, discuss with your doctor. You should also consult your doctor if you experience stomach pain with the drug.

INTERACTIONS

Antidepressants, chlorpropamide, chlorpromazine, fludrocortisone, and carbamazepine These drugs may increase the effects of desmopressin.

Indometacin and ibuprofen These anti-inflammatory drugs may increase the body’s response to desmopressin.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have heart problems.

· You have high blood pressure.

· You have kidney problems.

· You have cystic fibrosis.

· You have asthma or allergic rhinitis.

· You have epilepsy.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding The drug passes into breast milk, in small amounts, but adverse effects on the baby are unlikely.

Infants and children No special problems in children; infants may need monitoring to ensure that fluid balance is correct.

Over 60 May need monitoring to ensure that fluid balance is correct.

Driving and hazardous work No known problems.

Alcohol Your doctor may advise on fluid intake.

PROLONGED USE

Diabetes insipidus: no problems expected. Nocturnal enuresis: the drug will be withdrawn for at least a week after 3 months for assessment of the need to continue treatment.

Monitoring The levels of electrolytes (such as sodium) in the blood should be monitored periodically.