desmopressin acetate trihydrate: clinical use

Prescribing considerations

• Confirm objective evidence of vasopressin-sensitive central diabetes insipidus; unexplained polyuria is a contraindication.
• Assess fluid intake, baseline hydration and risk factors for hyponatraemia before treatment.
• Use caution with coronary disease, hypertension, renal impairment, cystic fibrosis, pregnancy and other fluid or electrolyte disturbances.
• Infants and older or frail patients are particularly susceptible to water and electrolyte imbalance.
• Intranasal absorption may be irregular when the nasal mucosa is oedematous, scarred, inflamed or otherwise abnormal.

Contraindications and cautions

• Hypersensitivity to desmopressin or an excipient.
• Existing hyponatraemia or a recognised risk of developing hyponatraemia.
• Primary polydipsia or polydipsia associated with alcohol misuse.
• Cardiac failure or another condition requiring diuretic treatment.
• Syndrome of inappropriate antidiuretic hormone secretion.
• Polyuria without an objective diagnosis of central diabetes insipidus.
• Type IIb von Willebrand disease or thrombotic thrombocytopenic purpura.

Monitoring

• Clinical fluid balance and symptoms of over- or under-treatment.
• Body weight and blood pressure.
• Plasma sodium and osmolality when clinically indicated, particularly in higher-risk patients.
• Urine volume and urine osmolality when assessing therapeutic response.
• Closely supervised fluid intake and urine osmolality during renal concentrating tests.

Clinical pharmacology

A synthetic vasopressin analogue that promotes water reabsorption in the distal nephron. Intranasal absorption is relatively rapid, systemic availability is limited, and renal elimination contributes to clearance.

Formulation and product differences

• The selected product is a multidose nasal spray licensed for central diabetes insipidus and diagnostic renal concentrating tests.
• Nasal mucosal disease can make delivery less reliable; oral and oromucosal formulations have different absorption characteristics.
• Store in the original packaging, upright and below the stated maximum temperature; discard after the in-use period specified in the leaflet.

Nasal preparation

Route: Nasal

Strengths: 10 micrograms/dose