Drugs List

Therapeutic Indications

Uses

Diabetes insipidus
Nocturnal enuresis
Post-op hypophysectomy polyuria/polydipsia

Contraindications

Children under 5 years - not for primary nocturnal enuresis
Patients over 65 years - not for primary nocturnal enuresis
Alcoholism
Cardiac impairment
Psychogenic polydipsia

Precautions and Warnings

Disorder of fluid balance
Disorders aggravated by fluid retention
Breastfeeding
Cardiovascular disorder
Cystic fibrosis
Electrolyte imbalance
Hypertension
Pregnancy
Raised intracranial pressure
Renal impairment

Not all available brands are licensed for all indications
Not all formulations are suitable for use in children under 2 years
Oral lyophilisate not suitable for children under 2 years
Nocturnal enuresis:limit fluids for 1hr before & 8hrs after administration
Monitor fluid and electrolyte status
Monitor weight and blood pressure
Nocturnal enuresis-reassess after 3 months by suspending therapy for 1 week
Pregnancy: Monitor blood pressure due to increased risk of pre-eclampsia
Suspend dose if vomiting/diarrhoea occurs until fluid/electrolytes normal
Discontinue if signs of fluid or electrolyte imbalance occur
Discontinue immediately if hyponatraemia occurs
Advise patient to seek medical advice if taking NSAIDs
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).

Pregnancy and Lactation

Pregnancy

Desmopressin should be given with caution to pregnant patients, although the oxytocic effect of desmopressin is very low.

Monitor blood pressure in pregnant patients due to the increased risk of pre-eclampsia. Data from a limited number of exposed pregnancies in women with diabetes insipidus indicate rare cases of malformations in children of mothers treated during their pregnancy, no other epidemiological information is available.

Animal studies have shown no direct or indirect harmful effects in relation to pregnancy, embryonal/foetal development, parturition 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)
Fluid retention
Headache
Hyponatraemia
Hyponatraemic convulsions
Nausea
Stomach pain
Vomiting
Weight gain

Presentation

Tablets containing desmopressin acetate

Drugs List

Therapeutic Indications

Uses

Diabetes insipidus
Nocturnal enuresis
Post-op hypophysectomy polyuria/polydipsia

Dosage

Adults

Elderly

Children

Contraindications

Children under 5 years - not for primary nocturnal enuresis
Patients over 65 years - not for primary nocturnal enuresis
Alcoholism
Cardiac impairment
Psychogenic polydipsia

Precautions and Warnings

Disorder of fluid balance
Disorders aggravated by fluid retention
Breastfeeding
Cardiovascular disorder
Cystic fibrosis
Electrolyte imbalance
Hypertension
Pregnancy
Raised intracranial pressure
Renal impairment

Not all available brands are licensed for all indications
Not all formulations are suitable for use in children under 2 years
Oral lyophilisate not suitable for children under 2 years
Nocturnal enuresis:limit fluids for 1hr before & 8hrs after administration
Monitor fluid and electrolyte status
Monitor weight and blood pressure
Nocturnal enuresis-reassess after 3 months by suspending therapy for 1 week
Pregnancy: Monitor blood pressure due to increased risk of pre-eclampsia
Suspend dose if vomiting/diarrhoea occurs until fluid/electrolytes normal
Discontinue if signs of fluid or electrolyte imbalance occur
Discontinue immediately if hyponatraemia occurs
Advise patient to seek medical advice if taking NSAIDs
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).

Pregnancy and Lactation

Pregnancy

Desmopressin should be given with caution to pregnant patients, although the oxytocic effect of desmopressin is very low.

Monitor blood pressure in pregnant patients due to the increased risk of pre-eclampsia. Data from a limited number of exposed pregnancies in women with diabetes insipidus indicate rare cases of malformations in children of mothers treated during their pregnancy, no other epidemiological information is available.

Animal studies have shown no direct or indirect harmful effects in relation to pregnancy, embryonal/foetal development, parturition 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)
Fluid retention
Headache
Hyponatraemia
Hyponatraemic convulsions
Nausea
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

British National Formulary, 65th Edition (March - September 2013) Pharmaceutical Press, London.
BNF for Children (2012-2013) Pharmaceutical Press, London.

Summary of Product Characteristics: DDAVP tablets 0.1mg. Ferring Pharmaceuticals Ltd. Revised June 2011.
Summary of Product Characteristics: DDAVP tablets 0.2mg. Ferring Pharmaceuticals Ltd. Revised June 2011.
Summary of Product Characteristics: Desmotabs 0.2mg. Ferring Pharmaceuticals Ltd. Revised June 2011.

Therapeutic Drugs 2nd edition ed. Dollery, C Churchill Livingstone, Edinburgh 1999.