desmopressin acetate: clinical use

Prescribing considerations

• Confirm the indication and formulation; bioavailability and licensed uses differ substantially.
• Assess fluid intake, sodium risk, renal and cardiovascular status, blood pressure, concurrent medicines and ability to follow fluid restrictions.
• Interrupt and reassess treatment during acute illness causing fluid or electrolyte disturbance.
• For haemostatic use, establish individual factor response and monitor blood pressure and fluid balance.

Contraindications and cautions

• Hypersensitivity to desmopressin or product excipients.
• Habitual or psychogenic polydipsia.
• Known hyponatraemia, predisposition to hyponatraemia or SIADH for relevant oral products.
• Moderate or severe renal impairment for relevant oral products.
• Heart failure, fluid-overload states or conditions requiring diuretics.
• Uncontrolled or abnormal blood pressure for relevant products.
• For haemostatic injection: unstable angina, decompensated cardiac failure and type 2B von Willebrand disease.
• Some enuresis products exclude patients older than 65 years.

Monitoring

• Serum sodium when risk factors are present.
• Body weight, fluid balance and symptoms of water retention where clinically indicated.
• Renal function and blood pressure according to indication and formulation.
• Factor response and clinical haemostasis when injection is used for bleeding disorders.

Clinical pharmacology

Desmopressin is a selective, long-acting vasopressin analogue with predominantly antidiuretic activity. It undergoes little hepatic metabolism and is substantially eliminated renally; food reduces oral absorption. Injectable desmopressin also increases factor VIII, von Willebrand factor and plasminogen-activator concentrations.

Formulation and product differences

• Sublingual tablets and oral lyophilisates dissolve under the tongue; some are fragile and must be peeled from the blister.
• The selected Sandoz sublingual tablet contains lactose.
• The selected oral lyophilisate contains gelatin and mannitol.
• The oral solution uses its supplied syringe, contains parahydroxybenzoates and has specific storage requirements after opening.
• Injection has different diagnostic and haemostatic uses and requires route-specific clinical supervision.
• Formulations are not interchangeable on a microgram-for-microgram basis because absorption differs.

Oral solution

Route: Oral

Strengths: 360 micrograms/mL

Tablet

Route: Oral

Strengths: 60 micrograms, 100 micrograms, 200 micrograms, 240 micrograms, 0.1 mg, 0.2 mg