Drugs List

Therapeutic Indications

Uses

Diabetes insipidus
Nocturia associated with multiple sclerosis (after other therapy failed)
Renal function testing

Contraindications

Alcoholism
Cardiac impairment
Hyponatraemia
Management of nocturia in Multiple Sclerosis in patients over 65 years
Psychogenic polydipsia
Renal impairment - creatinine clearance below 50ml/minute
Treatment of nocturia in Multiple Sclerosis with cardiovascular disorder

Precautions and Warnings

Disorders aggravated by fluid retention
Elderly
Cardiovascular disorder
Cystic fibrosis
Hypertension
Pregnancy
Raised intracranial pressure

Absorption may be irregular in patients with abnormal nasal mucosa
Not for treatment of von Willebrand's disease type 2B
Limit fluid intake from 1 hour before to 8 hours after treatment
Not suitable for delivering doses less than 10 micrograms
Diagnostic testing: prevent fluid overload
Monitor fluid and electrolyte status
Monitor weight and blood pressure
Renal function testing for infants under 1 should be supervised in hospital
Suspend dose if vomiting/diarrhoea occurs until fluid/electrolytes normal
Advise patient not to take NSAIDs unless advised by clinician
Advise patients to avoid excessive fluid intake

Hyponatraemic convulsions
The CSM has advised that patients being treated for primary nocturnal enuresis should be warned to avoid fluid overload (including during swimming) and to stop taking desmopressin during an episode of vomiting and diarrhoea (until fluid balance normal).
The risk of hyponatraemic convulsions can also be minimised by keeping to the recommended starting doses and by avoiding concomitant use of drugs which increase secretion of vasopressin (e.g. tricyclic antidepressants).

(The nasal spray is not indicated for this use as an increased incidence of adverse events has been reported)

Pregnancy and Lactation

Pregnancy

Desmopressin should be given with caution during pregnancy, although the oxytocic effect of desmopressin is very low.

Data from a limited number of pregnant women being treated with desmopressin for diabetes insipidus, indicate rare cases of malformation in children treated during pregnancy. No other epidemiological data is available. Blood pressure monitoring is recommended due to the increased risk of pre-eclampsia.

Animal studies have not shown any direct or indirect effects relating to pregnancy, embryonic/foetal development, delivery or postnatal development.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Results from analyses of milk from nursing mothers receiving high dose desmopressin (300 micrograms intranasally) indicated that the amounts of desmopressin that may be transferred to the child are considerably less than the amounts required to influence diuresis.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggression in children
Allergic reaction
Allergic skin reactions
Behavioural disturbances (children)
Epistaxis
Fluid retention
Headache
Hyponatraemia
Hyponatraemic convulsions
Nasal congestion
Nausea
Rhinitis
Stomach pain
Vomiting
Weight gain

Presentation

Nasal spray solution containing desmopressin acetate hydrate.

Drugs List

Therapeutic Indications

Uses

Diabetes insipidus
Nocturia associated with multiple sclerosis (after other therapy failed)
Renal function testing

Dosage

Diagnosis of cranial diabetes insipidus
When used for diagnostic purposes, fluid intake must be limited, not exceeding 500ml from 1 hour before administration and for 8 hours after.

Failure to elaborate a concentrated urine after water deprivation, followed by the ability to do so after the administration of desmopressin, confirms the diagnosis of cranial diabetes insipidus.
Failure to concentrate urine after the administration suggests nephrogenic diabetes insipidus.

Renal function testing
Adults and children over 1 year with normal renal function are expected to achieve urine concentrations above 700 mOsm/kg 5 to 9 hours following the administration.

Adults

Children

Contraindications

Alcoholism
Cardiac impairment
Hyponatraemia
Management of nocturia in Multiple Sclerosis in patients over 65 years
Psychogenic polydipsia
Renal impairment - creatinine clearance below 50ml/minute
Treatment of nocturia in Multiple Sclerosis with cardiovascular disorder

Precautions and Warnings

Disorders aggravated by fluid retention
Elderly
Cardiovascular disorder
Cystic fibrosis
Hypertension
Pregnancy
Raised intracranial pressure

Absorption may be irregular in patients with abnormal nasal mucosa
Not for treatment of von Willebrand's disease type 2B
Limit fluid intake from 1 hour before to 8 hours after treatment
Not suitable for delivering doses less than 10 micrograms
Diagnostic testing: prevent fluid overload
Monitor fluid and electrolyte status
Monitor weight and blood pressure
Renal function testing for infants under 1 should be supervised in hospital
Suspend dose if vomiting/diarrhoea occurs until fluid/electrolytes normal
Advise patient not to take NSAIDs unless advised by clinician
Advise patients to avoid excessive fluid intake

Hyponatraemic convulsions
The CSM has advised that patients being treated for primary nocturnal enuresis should be warned to avoid fluid overload (including during swimming) and to stop taking desmopressin during an episode of vomiting and diarrhoea (until fluid balance normal).
The risk of hyponatraemic convulsions can also be minimised by keeping to the recommended starting doses and by avoiding concomitant use of drugs which increase secretion of vasopressin (e.g. tricyclic antidepressants).

(The nasal spray is not indicated for this use as an increased incidence of adverse events has been reported)

Pregnancy and Lactation

Pregnancy

Desmopressin should be given with caution during pregnancy, although the oxytocic effect of desmopressin is very low.

Data from a limited number of pregnant women being treated with desmopressin for diabetes insipidus, indicate rare cases of malformation in children treated during pregnancy. No other epidemiological data is available. Blood pressure monitoring is recommended due to the increased risk of pre-eclampsia.

Animal studies have not shown any direct or indirect effects relating to pregnancy, embryonic/foetal development, delivery or postnatal development.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Results from analyses of milk from nursing mothers receiving high dose desmopressin (300 micrograms intranasally) indicated that the amounts of desmopressin that may be transferred to the child are considerably less than the amounts required to influence diuresis.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Counselling

Advise patients receiving desmopressin treatment to avoid fluid overload (including during swimming) and to stop taking desmopressin during an episode of vomiting and diarrhoea (until fluid balance normal).

Advise patients on the need to restrict fluid intake 1 hour before and for 8 hours after administration for diagnostic tests and nocturnal enuresis in multiple sclerosis.

Ensure that patients are aware of the correct use of the product, and, in particular, that they should discharge the spray to waste until a consistent spray is seen (about 5 sprays on first use of a new spray).

Advise patient to avoid taking NSAIDs concurrently with this medication as these may induce water retention and/ or hyponatraemia.

Side Effects

Aggression in children
Allergic reaction
Allergic skin reactions
Behavioural disturbances (children)
Epistaxis
Fluid retention
Headache
Hyponatraemia
Hyponatraemic convulsions
Nasal congestion
Nausea
Rhinitis
Stomach pain
Vomiting
Weight gain

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: April 2013

Reference Sources

Summary of Product Characteristics: Desmopressin nasal spray 10mcg/dose. Actavis UK Ltd. Revised July 2015.

Summary of Product Characteristics: Desmospray, Desmopressin Nasal Spray. Ferring Pharmaceuticals Ltd. Revised June 2011.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 17 August 2017