Desmopressin (1-deamino-8-D-arginine vasopressin) is a synthetic analog of arginine vasopressin (antidiuretic hormone, or ADH). Desmopressin is more potent and much longer acting than vasopressin. Desmopressin is used to prevent or control symptoms of central diabetes insipidus (e.g., polyuria, polydipsia, and dehydration); it is not effective for nephrogenic diabetes insipidus. The drug is also used to control polydipsia and polyuria that occur following pituitary surgery or head trauma, and the tablets are approved for managing primary nocturnal enuresis (PNE); however, the intranasal formulation is no longer indicated to treat PNE secondary to reports of hyponatremic-related seizures sometimes resulting in death. An intranasal formulation and sublingual formulation are available for the treatment of nocturia due to nocturnal polyuria in adults; the oral formulation is not FDA approved for this indication. Nasal preparations of desmopressin have about one-tenth the antidiuretic effect of an intravenously administered dose, but both forms are effective clinically. The intranasal formulation has a longer duration of action; however, the oral formulation of desmopressin may be preferred for chronic therapy and for patients who do not tolerate intranasal administration. Desmopressin is also indicated for the management of bleeding episodes in patients with mild to moderate hemophilia A or von Willebrand's disease type 1. Desmopressin can shorten or normalize bleeding time and correct platelet adhesion abnormalities in certain patients with bleeding disorders. The FDA approved desmopressin in 1978.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
Oral Tablets
-If converting from intranasal therapy, administer oral dose 12 hours after last intranasal dose.
-Patient response to each dose should be determined by adequate duration of sleep and adequate, not excessive, water turnover.
Sublingual Tablets
-The patient should place the tablet under their tongue 1 hour before bedtime until it dissolves.
-Have the patient empty their bladder just before bedtime.
-Advise patients to limit the amount of water or liquids they drink from 1 hour before taking desmopressin sublingual tablet and until 8 hours after. They should also avoid drinks containing caffeine and alcohol before bedtime.
Injectable Administration
-Desmopressin is administered intravenously or subcutaneously.
-Desmopressin (DDAVP) injection has an antidiuretic hormone activity of 16 International Units/mL; 1 mcg desmopressin is equivalent to 4 International Units antidiuretic hormone activity.
-If given preoperatively, desmopressin injection should be given 30 minutes before the scheduled procedure.
-Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Intravenous Administration
Direct intravenous injection
-No dilution necessary.
-Inject IV over 1 minute.
Intermittent intravenous infusion
-For adults and children weighing greater than 10 kg, dilute dose in 50 mL of 0.9% Sodium Chloride for injection. For children weighing less than 10 kg, dilute dose in 10 mL 0.9% Sodium Chloride for injection.
-Infuse IV slowly over 15 to 30 minutes.
-Pulse and blood pressure should be monitored during infusion.
Subcutaneous Administration
-Inject subcutaneously taking care not to inject intradermally.
Inhalation Administration
Intranasal Inhalation Administration
-Desmopressin nasal sprays may not be substituted for each other due to significant differences in concentration.
DDAVP Nasal Spray
-DDAVP nasal spray delivers doses in 0.1 mL (10 mcg) increments. If doses other than these are required, the rhinal tube delivery system may be used.
-One spray (10 mcg) has an antidiuretic activity of about 40 International Units.
-The nasal spray must be primed prior to first use. To prime, press down 4 times. The pump will stay primed for up to 1 week. If the product has not been used for a period of 1 week, re-prime the pump by pressing once.
-Instruct patient on the proper technique for administering the nasal spray. Tilt bottle so that the tube inside the bottle draws from the deepest portion of the medication.
-To avoid the spread of infection, do not use the container for more than 1 person.
-For 5 mL bottles, discard after 50 sprays (doses), and for 2.5 mL bottles, discard after 25 sprays (doses) because the amount delivered thereafter per spray may be substantially less than the recommended dose. Do not transfer any remaining solution to another bottle.
DDAVP Rhinal Tube
-DDAVP Rhinal tube is used to administer desmopressin doses less than 10 mcg (less than 0.1 mL).
-Break the seal on the bottle and remove cap. Twist off the seal from the dropper. Keep this seal as it is reversed to prevent leakage from the dropper.
-Squeeze the correct dose into this tube from the dropper bottle. Once the dose is in the tube, hold the tube with your fingers, about 3/4 inch from the end.
-Put the tube into a nostril, until your fingers touch the nostril. Put the other end of the tube into the patients mouth; the patient should hold their breath.
-Tilt the patient's head back and have them blow with a short strong puff through the tube. This places the solution in the nasal cavity and not down your throat.
-After use, reseal the dropper tip and close the bottle. Wash the rhinal tube in water and shake well, until no water is left in the tube.
-To avoid the spread of infection, do not use the container for more than 1 person.
-For 2.5 mL bottles, discard after 25 sprays (doses) because the amount delivered thereafter per spray may be substantially less than the recommended dose. Do not transfer any remaining solution to another bottle.
Stimate Nasal Spray
-Stimate nasal spray delivers doses in 0.1 mL (150 mcg) increments. If doses other than these are required, parenteral desmopressin injection must be used.
-One spray (150 mcg) has an antidiuretic activity of about 600 International Units.
-The nasal spray must be primed prior to first use. To prime, press down 4 times. The pump will stay primed for up to 1 week. If the product has not been used for a period of 1 week, re-prime the pump by pressing once.
-Instruct patient on the proper technique for administering the nasal spray. Tilt bottle so that the tube inside the bottle draws from the deepest portion of the medication.
-If given preoperatively, intranasal desmopressin should be administered 2 hours before surgery.
-To avoid the spread of infection, do not use the container for more than 1 person.
-Discard spray pump after 25 sprays since the amount delivered thereafter per spray may be substantially less than the recommended dose. Do not transfer any remaining solution to another bottle.
Noctiva Nasal Spray
-Noctiva nasal spray delivers either 0.83 mcg or 1.66 mcg of desmopressin acetate (equivalent to 0.75 mcg or 1.5 mcg of desmopressin) per spray (0.1 mL).
-Two sprays of the 0.83 mcg nasal spray are not interchangeable with 1 spray of the 1.66 mcg nasal spray; the 1.66 mcg/0.1 mL nasal spray should be prescribed for patients who are or will be taking the 1.66 mcg dose.
-Do NOT shake the bottle.
-Prime the nasal spray before using for the first time by pumping 5 actuations into the air away from the face. If the product has not been used for more than 3 days, re-prime by pumping 2 actuations into the air.
-Instruct the patient to blow their nose, tilt the head back slightly, and insert the nasal applicator into the left or right nostril, keeping the nasal applicator upright. The patient should close the open nostril with a finger from the empty hand and gently inhale while the nasal applicator is pumped 1 time. Avoid spraying in the eyes. Gently breathe in through the nose and out through the mouth several times.
-Wipe the nasal applicator using a clean tissue and replace the cap on the bottle.
-To avoid the spread of infection, do not use the container for more than 1 person.
-Do not co-administer with other intranasal products.
-Discard nasal spray 60 days after opening.
Infrequently, large doses of the intranasal and parenteral formulations of desmopressin have produced transient nausea and mild abdominal pain or cramps; xerostomia may be a complaint. These symptoms have disappeared with reduction in dosage and rarely may require discontinuance of therapy. Stomach upset, dyspepsia, or diarrhea are rarely reported. In patients receiving desmopressin sublingual therapy for nocturia, xerostomia was one of the most frequently reported adverse events and was reported in 12% of women and 14% of men.
Infrequently, high dosages of intranasal or parenteral desmopressin have produced transient headache (2% at 20 mcg/day intranasal dosage and 5% at 40 mcg/day intranasal dosage). In studies for enuresis, headache was reported with oral use in 4% of patients. In patients receiving desmopressin sublingual therapy for nocturia, headache (2% of women and 4% of men) and dizziness (2% of women and 3% of men) were among the most frequently reported adverse events. Dizziness was reported in 3% of patients receiving intranasal desmopressin at 40 mcg/day dosage, but 0% of patients receiving 20 mcg/day intranasally, and this side effect might be noticed in a small percentage of patients receiving other dosage forms. Headache and other mild symptoms disappeared with reduction in dosage. During trials with desmopressin nasal spray in patients with nocturia, dizziness was reported in 2%, 1.8%, and 1.4% of patients receiving 0.83 mcg, 1.66 mcg, and placebo, respectively. Due to the potent antidiuretic effects of desmopressin, hyponatremia leading to water intoxication, seizures, and/or coma can occur, especially in elderly or pediatric patients. Unless properly diagnosed and treated hyponatremia can be serious, and potentially fatal. Estimated frequencies for hyponatremia for various desmopressin dosage forms from the literature during study of patients in clinical practice range from 0.9% to 12%. During trials with desmopressin nasal spray in patients with nocturia, there was 1 case of hyponatremia in the desmopressin 1.66 mcg group and 1 case in the placebo group that were classified as serious adverse reactions. Five patients (1.5%) receiving desmopressin 1.66 mcg had serum sodium concentrations of 125 mmol/L or less. Four of these patients were taking a concomitant systemic or inhaled glucocorticoid, and 3 were taking a nonsteroidal antiinflammatory drug (NSAID). Hyponatremia/decreased blood sodium was the most common adverse reaction leading to discontinuation of desmopressin for nocturia; 0.9% of patients receiving 0.83 mcg, 1.2% of patients receiving 1.66 mcg, and 0.3% of patients receiving placebo discontinued therapy for this reason. In patients receiving desmopressin sublingual therapy for nocturia, hyponatremia or decreased blood sodium was one of the most frequently reported adverse events and was reported in 3% of women and 4% of men. Hyponatremia was the most common reaction leading to discontinuation of therapy. Serum sodium was measured during screening, at baseline, and on all study visits during treatment. In a pooled analysis of 3 phase 3 studies, serum sodium concentrations were: 130 to 134 mmol/L for 7% of women and 17% of men, 126 to 129 mmol/L for 4% of women and less than 1% of men, and less than 125 mmol/L for none of the women and 2% of men. Patients or caregivers should be alert to symptoms that may indicate water intoxication. In pediatric patients, seizures are often preceded by headache, nausea or vomiting that occur in the morning, and by a delayed first morning voiding after administration of the drug in the evening. Patients should be advised to restrict their fluid intake while taking desmopressin. All patients should be observed for signs and symptoms associated with hyponatremia (e.g., headaches, nausea, vomiting, lethargy, disorientation or confusion, altered thinking, and depressed reflexes). In postmarket reports, hyponatremic convulsions due to desmopressin were associated with concomitant use with the following medications: oxybutynin and imipramine. The risk of water intoxication and hyponatremia can also be increased in patients receiving the drug to maintain hemostasis because these patients are not deficient in endogenous vasopressin. Hyponatremia and related symptoms can usually be resolved with dosage reduction. Severe water retention can be corrected by administration of a diuretic agent. During postmarketing surveillance, severe hyponatremia has been reported; 61 cases of hyponatremia-induced seizures have been reported to the FDA. In 55 of these cases, during the seizure, the sodium concentration ranged from 104 to 130 mEq/L; 2 of the patients died. Several cases involved the intranasal formulation, and most cases were reported in pediatric patients younger than 17 years old. In response to an FDA request for removal of the indication, the intranasal formulation is no longer indicated for the treatment of primary nocturnal enuresis secondary to these postmarketing reports of hyponatremic-related seizures, which most often occurred in pediatric patients; consider other treatment options for this condition. In the literature alone, 54 cases are noted; in most cases, the complication developed 14 days or less after starting desmopressin, and 47 patients were receiving intranasal dosing. Excess fluid intake was a contributing factor in at least 22 cases, and in 6 cases severe signs of hyponatremia developed in the context of intercurrent illnesses. These cases underscore the need for proper monitoring and education to ensure proper adherence to fluid restriction.
Infrequently, large doses of the intranasal and parenteral formulations of desmopressin have produced transient flushing. These symptoms have disappeared with reduction in dosage.
Chills (2% at higher doses) and asthenia (2% at higher doses) are some of the general body adverse reactions associated with the use of intranasal desmopressin.
Transient elevated hepatic enzymes may occur with oral desmopressin treatment. In long-term clinical studies in which patients with diabetes insipidus were followed for periods up to 44 months of oral desmopressin therapy, transient increases in AST (SGOT) no higher than 1.5 times the upper limit of normal were occasionally observed. Elevated AST (SGOT) returned to the normal range despite continued oral desmopressin therapy.
Although structural changes in desmopressin result in less vasopressor and smooth muscle activity versus arginine vasopressin, desmopressin infrequently causes hypertension or hypotension, facial flushing, palpitations, and a compensatory sinus tachycardia in some patients. Oral desmopressin however, has not been associated with hypertension. Rare reports of thrombosis, including thromboembolism, cerebrovascular thrombosis (stroke), and myocardial infarction have been associated with desmopressin administration. However, no causality has been determined for these thrombotic events. In patients receiving desmopressin nasal spray for nocturia, hypertension/increased blood pressure was reported in 1.7% and 2.6% of patients receiving 0.83 mcg and 1.66 mcg, respectively.
Upper respiratory adverse reactions have been reported with the use of intranasal desmopressin. Adverse reactions reported include epistaxis (3%), nostril pain or rhinalgia (2%), nasal congestion, and rhinitis (3% to 8%). Sore throat, cough, and upper respiratory infections have also been reported. Nasal discomfort (3.4% to 5.9%), naso-pharyngitis (2.3% to 3.8%), nasal congestion (1.4% to 2.9%), sneezing (2.3% to 2.6%), bronchitis (0.8% to 2.1%), and epistaxis (2% to 2.1%) have been reported in patients receiving desmopressin nasal spray for nocturia.
Severe allergic reactions (anaphylactoid reactions) have rarely been reported to desmopressin. One fatal case of anaphylactic shock has been documented. It is not known if antibodies to desmopressin are formed with repeated use.
Ocular adverse reactions associated with intranasal administration of desmopressin include itchy or light-sensitive eyes, resulting in ocular pruritus or photophobia. Conjunctivitis, periorbital edema, and lacrimation disorder, each occurring in 2% or less, have been reported with intranasal administration as well.
Occasionally, injection of desmopressin has produced an injection site reaction consisting of local erythema, swelling or burning pain.
Balanitis has been reported with the intranasal administration of desmopressin. There are literature data in mice which describe an effect of desmopressin and vasopressin on spermatozoa, leading to reduced sperm counts (oligospermia) and altered sperm motility, which may have implications for human male infertility.
The occurrence of tachyphylaxis (tolerance) is more common if doses of desmopressin are administered more frequently than every 48 hours. Repeated intravenous doses of desmopressin every 12 to 24 hours have shown a diminution of the factor VIII activity increase that occurs after a single dose. In hemophilia patients and von Willebrand's disease patients who were treated with desmopressin every 24 hours for 4 doses, the response to the second dose was about 30% less than the response to the first dose. Tachyphylaxis is usually not a problem clinically in the treatment of bleeding as most patients respond after 1 to 2 doses. It may be possible to reproduce the initial response in some patients after 1 week of drug discontinuation, but other patients may require up to 6 weeks time for tachyphylaxis to reverse. There are reports of changes in antidiuretic response (e.g., decreased responsiveness or shortened duration of effect) to intranasal formulations of desmopressin. Usually this occurs over a period of more than 6 months. No lessening of effect was noted in a group of patients treated with oral desmopressin for 12 to 44 months.
Back pain was reported in 1.1% to 2.3% of patients receiving desmopressin nasal spray for nocturia.
Desmopressin is contraindicated in patients with known hypersensitivity to desmopressin or any ingredients in the preparation. Severe allergic reactions, including anaphylaxis, have been reported with intravenous and intranasal desmopressin. Fatal anaphylaxis has been reported with intravenous desmopressin. It is not known whether antibodies to desmopressin injection are produced after repeated injections. Monitor patients for signs or symptoms of hypersensitivity reactions during administration, interrupt treatment should a reaction occur, and manage medically. Permanently discontinue for serious hypersensitivity reaction.
In general, desmopressin is contraindicated in persons with heart failure or uncontrolled hypertension because fluid retention increases the risk for worsening of underlying conditions that are susceptible to volume status. Use desmopressin nasal spray for nocturia with caution and monitoring of blood volume status in persons with New York Heart Association Class I congestive heart failure. Desmopressin is not recommended for use in persons with increased intracranial pressure or those with a history of urinary retention. Monitor blood pressure during desmopressin administration, particularly in persons with coronary artery disease (insufficiency) and/or hypertension; desmopressin may cause hypotension (with compensatory increase in heart rate) or hypertension.
Desmopressin is contraindicated in persons with moderate to severe renal impairment (CrCl less than 50 mL/minute or eGFR less than 50 mL/minute/1.73 m2) and renal failure. Persons with renal disease may be at increased risk for low sodium concentrations, fluid overload, and electrolyte abnormalities. However, desmopressin is used off-label as a single injection for uremic bleeding in persons with renal failure. Repeat dosing is not recommended; therefore, the risk of toxicities associated with accumulation of desmopressin is expected to be low, especially with single-dose intermittent use and appropriate monitoring.
Desmopressin is contraindicated in persons with hyponatremia or a history of hyponatremia, polydipsia, concomitant loop diuretic or systemic or inhaled corticosteroid therapy, known or suspected syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and other illnesses that can cause fluid and electrolyte imbalance, such as gastroenteritis, salt-wasting nephropathies, or systemic infection. Persons with conditions associated with fluid and electrolyte imbalance (i.e., cystic fibrosis, heart failure, renal disorders), habitual or psychogenic polydipsia who may drink excessive amounts of water as well as elderly or pediatric (e.g., infants, children) patients and those receiving concomitant drugs that also cause hyponatremia may be at increased risk of hyponatremia. Ensure the serum sodium concentration is within normal limits prior to starting or resuming desmopressin therapy. Limit fluid intake to a minimum 1 hour before and 8 hours after administration. Monitor serum sodium concentrations within 1 week and then approximately 1 month after treatment initiation and periodically thereafter.
Desmopressin is not effective in persons with type 3 von Willebrand's disease (vWD) and can cause platelet aggregation, thrombocytopenia, and possibly thrombosis in persons with type 2B vWD. Many persons with type 2 vWD do not respond to desmopressin and require alternate treatment; however, a desmopressin trial can help confirm diagnosis and may be useful in some instances of mild bleeding in persons with type 2 vWD. Confirm responsiveness before using desmopressin for therapeutic interventions. Persons with vWD type 1 and von Willebrand factor (vWF) concentrations less than 0.3 International Units/mL or factor VIII activity equal to or less than 5% of normal may not respond to desmopressin. Desmopressin is not indicated for persons with severe classic vWD (type 1), for the treatment of hemophilia B, or in persons with factor VIII antibodies. In certain clinical situations, it may be justified to try desmopressin in persons with factor VIII concentrations of 2% to 5%; however, carefully monitor these patients. Persons with vWD subtype 1C, which is characterized by a shorted vWF half-life, may require alternative management in the setting of surgery. Do not use desmopressin as sole therapy in persons with vWD undergoing major surgery.
Administration of intranasal desmopressin may be compromised by nasal mucosa changes (e.g., nasal trauma, nasal surgery, nasal blockage, nasal mucosal atrophy, congestion, or severe atrophic rhinitis), cranial surgery, and nasal packing. Chronic desmopressin administration may result in changes to nasal mucosa (scarring and edema), which may cause erratic and unreliable absorption. Intravenous desmopressin should be considered when indicated. Although the manufacturer states that nasal congestion does not affect the absorption of intranasal desmopressin, some clinicians recommend a higher dose. In patients receiving desmopressin nasal spray for nocturia, discontinue treatment in patients with concurrent nasal conditions that may increase systemic absorption of desmopressin (e.g., atrophy of nasal mucosa, and acute or chronic rhinitis), because the increased absorption may increase the risk of hyponatremia. Desmopressin nasal spray can be resumed when these conditions resolve.
In general, most reported clinical experience with desmopressin has not identified efficacy response differences between geriatric and younger patients. Geriatric patients 65 years of age and older treated with desmopressin for nocturia had a higher incidence of hyponatremia compared to patients less than 65 years old; therefore, monitor serum sodium more frequently in these patients. The risk of toxic reactions (including water intoxication and low sodium concentrations) appears to be greater in the geriatric patient and other patients with impaired renal function. In general, dose selection for the geriatric patient should be cautious, usually starting at the low end of the dosing range. Baseline renal function should be assessed. Desmopressin is contraindicated in patients with moderate to severe renal impairment (e.g., CrCl less than 50 mL/minute or eGFR less than 50 mL/minute/1.73 m2). Monitor renal function and clinical status closely during use. According to the Beers Criteria, desmopressin is considered a potentially inappropriate medication (PIM) in geriatric adults and avoidance is recommended for treating nocturia or nocturnal polyuria because there is a high risk of hyponatremia and safer alternatives are available.
Prolonged experience with desmopressin in pregnant women over several decades, based on the available published literature and case reports, have not identified a drug associated risk of major birth defects, miscarriage or other adverse maternal or fetal outcomes. In addition, in vitro studies with human placenta demonstrate poor placental transfer of desmopressin. The use of desmopressin for nocturia is not recommended in pregnant women; nocturia is usually related to normal, physiologic changes during pregnancy that do not require treatment with desmopressin. No adverse developmental outcomes were observed in animal reproduction studies with administration of desmopressin during organogenesis to pregnant rats and rabbits at doses approximately less than 1 and 38 times, respectively, the maximum recommended human dose based on body surface area (mg/m2). A systematic review of 30 studies of desmopressin for the treatment and prophylaxis of bleeding disorders in pregnancy (n = 216) concluded that the drug is effective in reducing bleeding complications associated with pregnancy and childbirth with a good safety record. Desmopressin has been used safely in many women during pregnancy, including those with bleeding disorders and diabetes insipidus. Desmopressin should be avoided in women with preeclampsia and those with cardiovascular disease due to the fact that oxytocin and IV fluids are often used during labor and delivery, both of which increase the risk of desmopressin-induced hyponatremia. Consider risk vs. benefit as pregnant women with Hemophilia A or von Willebrand's disease as these patients may be at an increased risk for bleeding diatheses and hemorrhagic events at delivery; affected neonates may also be at risk of bleeding diatheses. Use careful attention to fluid management to avoid hyponatremia in the peripartum and postpartum period and weigh the possible therapeutic advantages against the possible risks in each individual case.
Caution should be exercised when desmopressin is administered to a woman who is breast-feeding. Desmopressin is present in small amounts in human milk and is poorly absorbed by an infant. There is no information on the effects of desmopressin on the breast-fed infant or on milk production. In a single study of postpartum women receiving a single dose of intranasal desmopressin, a marked change in plasma concentration of desmopressin was seen; however, little, if any, change in assayable desmopressin was found in breast milk. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.
General dosing information
Switching between desmopressin formulations
-Always titrate individually according to diuresis and serum sodium concentrations.
-Conversion from nasal spray to the injection: Initiate the injection at one-tenth of the nasal spray dose.
-Conversion from tablets to injection: Titrate the dose according to diuresis and serum sodium concentrations. Monitor closely during the initial dose titration timeframe.
For the management of patients with central diabetes insipidus (neurohypophyseal diabetes insipidus) including polydipsia and polyuria which occurs after head surgery or trauma:
Oral dosage:
Adults: Initially, 0.05 mg PO twice daily, then titrate to response. The usual dosage range is 0.1 mg to 1.2 mg PO per day, given in 2 to 3 divided doses. If patients are receiving intranasal therapy, begin oral therapy 12 hours after the last intranasal dose. During the initial titration period and continued therapy, observe and monitor closely. Adjust treatment according to the diurnal pattern of response. Response should be estimated by 2 parameters, adequate duration of sleep and adequate, not excessive, water turnover. In the elderly, careful fluid intake restrictions are required to prevent hyponatremia and water intoxication.
Children and Adolescents 4 to 17 years: Initially, 0.05 mg PO twice daily. Adjust doses based on patient's diurnal pattern of response. The usual dosage range is 0.1 mg to 1.2 mg PO per day, given in 2 to 3 divided doses. If patients are receiving intranasal therapy, begin oral therapy 12 hours after last intranasal dose. During initial titration and continued therapy, observe and monitor closely; adjust treatment to the diurnal pattern of response. Response should be estimated by 2 parameters, adequate duration of sleep and adequate, not excessive, water turnover. Careful fluid intake restrictions are required in pediatric patients to prevent hyponatremia and water intoxication.
Children younger than 4 years: Initially, 0.05 mg PO once daily. Individualize dosing to prevent an excessive decrease in plasma osmolality, which can lead to hyponatremia and possible seizures. During the initial titration period and continued therapy, observe and monitor closely; treatment should be adjusted according to the diurnal pattern of response. Response should be estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. Fluid intake restrictions in these patients are recommended.
Intranasal dosage (DDAVP 0.01% nasal solution):
Adults: Initially, 10 mcg (0.1 mL) intranasally into 1 nostril, may increase to 40 mcg until the patient can sleep for an adequate period of time without incidence of polyuria. Maintenance dose range: 10 mcg/day to 40 mcg/day intranasally (0.1 mL/day to 0.4 mL/day) in 1 to 3 divided doses. If administered more than once a day, adjust for an adequate diurnal rhythm of urine output. If the patient was previously receiving desmopressin injection, administer 10 times the amount of desmopressin acetate, rounding down to the nearest 10 mcg. If the patient was previously receiving desmopressin tablets, dose titration is required because intranasal desmopressin is approximately 10 to 40 fold more potent than oral (tablet) desmopressin.
Children and Adolescents 4 to 17 years: Initially, 10 mcg (0.1 mL) intranasally into 1 nostril, may increase to 30 mcg until the patient can sleep for an adequate period of time without incidence of polyuria. Maintenance dose range: 10 mcg/day to 30 mcg/day intranasally (0.1 mL/day to 0.3 mL/day) in 1 to 2 divided doses. If 30 mcg is divided, typically 20 mcg is given in the morning, and 10 mcg is given at night. Adjust for an adequate diurnal rhythm of urine output. If the patient was previously receiving desmopressin injection, administer 10 times the amount of desmopressin acetate, rounding down to the nearest 10 mcg. If the patient was previously receiving desmopressin tablets, dose titration is required because intranasal desmopressin is approximately 10 to 40 fold more potent than oral (tablet) desmopressin.
Intranasal dosage (DDAVP rhinal tube solution):
Adults: Initially, 10 mcg (0.1 mL) intranasally, given in 1 to 3 divided doses, then titrated to response. The recommended maintenance dose is 10 mcg/day to 40 mcg/day intranasally (0.1 mL/day to 0.4 mL/day) in 1 to 3 divided doses. Most adults require a maintenance dose of 20 mcg/day, administered as 10 mcg intranasally twice daily. Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. Fluid restrictions should be observed. In the elderly, careful dosage selection and monitoring of renal function are recommended.
Adolescents 13 to 17 years: Initially, 10 mcg (0.1 mL) intranasally, given in 1 to 3 divided doses, then titrated to response. The recommended maintenance dose is 10 mcg/day to 40 mcg/day intranasally (0.1 mL/day to 0.4 mL/day) in 1 to 3 divided doses. Most patients require a maintenance dose of 20 mcg/day, administered as 10 mcg intranasally twice daily. Adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover. Fluid restrictions should be observed. In the elderly, careful dosage selection and monitoring of renal function are recommended.
Infants and Children 3 months to 12 years: Initially, 5 mcg (0.05 mL) intranasally, given in 1 to 2 divided doses, then titrated to response. In infants, doses less than 5 mcg (0.05 mL) may be necessary. The recommended maintenance dose is 5 mcg/day to 30 mcg/day (0.05 mL/day to 0.3 mL/day) intranasally in single or divided doses. About 1/4 to 1/3 of patients can be controlled by a single daily dose. Fluid restrictions should be observed.
Intravenous and Subcutaneous dosage:
Adults: 2 to 4 mcg IV or subcutaneously given in 1 to 2 divided doses daily. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Adjust dose based upon response to treatment estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. Alternatively, if the patient was previously receiving intranasal therapy, the usual dose is one-tenth (1/10) of the intranasal maintenance dose. Careful fluid intake restrictions are required to prevent hyponatremia and water intoxication.
Adolescents and Children 12 to 17 years: 2 to 4 mcg IV or subcutaneously given in 1 or 2 divided doses daily. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Adjust dose based upon response to treatment estimated by 2 parameters: adequate duration of sleep and adequate, not excessive, water turnover. Alternatively, if the patient was previously receiving intranasal therapy, the usual dose is one-tenth (1/10) of the intranasal maintenance dose. Careful fluid intake restrictions are required to prevent hyponatremia and water intoxication.
For the treatment of primary nocturnal enuresis:
Oral dosage:
Adults: Initially, 0.2 mg PO once daily at bedtime. Doses may be titrated up to 0.6 mg PO once daily at bedtime, depending on individual patient response. Fluid restriction should be observed, and fluid intake should be limited to a minimum from 1 hour before administration, until the next morning, or at least 8 hours after administration. Interrupt therapy for acute illness (e.g., systemic infection, fever, recurrent vomiting or diarrhea), extremely hot weather, vigorous exercise, or other conditions associated with increased water intake. Patients previously receiving intranasal treatment may begin oral therapy the night following (24 hours) the last intranasal dose.
Children and Adolescents 6 years and older: Initially, 0.2 mg PO once daily at bedtime. Doses may be titrated up to 0.6 mg PO once daily at bedtime, depending on individual patient response. Fluid restriction should be observed, and fluid intake should be limited to a minimum from 1 hour before administration, until the next morning, or at least 8 hours after administration. Interrupt therapy for acute illness (e.g., systemic infection, fever, recurrent vomiting or diarrhea), extremely hot weather, vigorous exercise, or other conditions associated with increased water intake. Treatment has been given safely to pediatric patients for up to 6 months. Patients previously receiving intranasal treatment may begin oral therapy the night following (24 hours) the last intranasal dose.
Intranasal dosage (DDAVP 0.01% nasal solution or generic equivalents)*:
Adults: As of 2007 in response to a FDA request for removal of the indication, the intranasal formulation is no longer indicated for the treatment of primary nocturnal enuresis secondary to post-marketing reports of hyponatremic-related seizures, which most often occurred in pediatric patients. Consider other treatment options for this condition. The previously recommended dose: 20 mcg (0.2 mL) intranasally of the 0.01% nasal solution at bedtime, with one-half of the dose administered into each nostril. If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. Typical maintenance dose was 10 to 40 mcg/day (0.1 to 0.4 mL/day). If patient responded to 20 mcg/day, the dose was adjusted downward to 10 mcg/day to see if response could be maintained. Fluid restriction was to be observed, with fluid intake was limited to a minimum from 1 hour before intranasal administration, until the next morning, or at least 8 hours after administration. Treatment longer than 4 to 8 weeks has not been studied. Patients receiving intranasal treatment could begin oral therapy the night following (24 hours) the last intranasal dose.
Children and Adolescents 6 years and older: As of 2007 the intranasal formulation is no longer FDA-approved for the treatment of primary nocturnal enuresis secondary to postmarketing reports of hyponatremia-related seizures, which most often occurred in children using the intranasal formulation. Consider other treatment options for this condition. The previously recommended dose: 20 mcg (0.2 mL) intranasally of the 0.01% nasal solution at bedtime, with one-half of the dose administered into each nostril. If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. Typical maintenance dose was 10 to 40 mcg/day (0.1 to 0.4 mL/day). If patient responded to 20 mcg/day, the dose was adjusted downward to 10 mcg/day to see if response could be maintained. Fluid restriction was to be observed, with fluid intake was limited to a minimum from 1 hour before intranasal administration, until the next morning, or at least 8 hours after administration. Patients receiving intranasal treatment could begin oral therapy the night following (24 hours) the last intranasal dose.
For bleeding prophylaxis and prevention and control of surgical bleeding or spontaneous or traumatic hemorrhage in patients with hemophilia A or mild to moderate classic von Willebrand's disease (type 1) and factor VIII activity concentrations more than 5%:
NOTE: Desmopressin has been designated an orphan drug by the FDA for mild hemophilia A and von Willebrand's disease.
NOTE: Confirm responsiveness before using desmopressin for therapeutic interventions. A desmopressin response requires an increase of at least 2 times the baseline von Willebrand factor (vWF) activity and an increase of both vWF and factor VIII concentrations of more than 0.5 International Units/mL for at least 4 hours. If a desmopressin challenge is not practical, it can be presumed adults with type 1 von Willebrand's disease whose baseline vWF concentrations are 0.3 International Units/mL or more are desmopressin responsive.
NOTE: Desmopressin may be utilized in certain scenarios in persons with hemophilia A and factor VIII concentrations between 2% to 5%. Monitor carefully.
Intranasal dosage (Stimate 1.5 mg/mL nasal spray):
NOTE: Use parenteral desmopressin in patients for whom the intranasal route is compromised or inappropriate.
Adults weighing 50 kg or more: 150 mcg into each nostril once for a total dose of 300 mcg. If used preoperatively, administer 2 hours before surgery. Determine need for repeat dosage based on laboratory response and patient's clinical condition. Most patients respond to 1 to 2 doses; administer a second dose 8 to 24 hours after the first dose if needed. To minimize risk of hyponatremia and seizures, administer no more than once every 24 hours or for more than 3 consecutive days. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours.
Adults weighing less than 50 kg: 150 mcg into 1 nostril once for a total dose of 150 mcg. If used preoperatively, administer 2 hours before surgery. Determine need for repeat dosage based on laboratory response and patient's clinical condition. Most patients respond to 1 to 2 doses; administer a second dose 8 to 24 hours after the first dose if needed. To minimize risk of hyponatremia and seizures, administer no more than once every 24 hours or for more than 3 consecutive days. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours.
Children and Adolescents weighing 50 kg or more: 150 mcg into each nostril once for a total dose of 300 mcg. If used preoperatively, administer 2 hours before surgery. Determine need for repeat dosage based on laboratory response and patient's clinical condition. Most patients respond to 1 to 2 doses; administer a second dose 8 to 24 hours after the first dose if needed. To minimize risk of hyponatremia and seizures, administer no more than once every 24 hours or for more than 3 consecutive days. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours.
Infants, Children, and Adolescents 11 months to 17 years weighing less than 50 kg: 150 mcg into 1 nostril once for a total dose of 150 mcg. If used preoperatively, administer 2 hours before surgery. Determine need for repeat dosage based on laboratory response and patient's clinical condition. Most patients respond to 1 to 2 doses; administer a second dose 8 to 24 hours after the first dose if needed. To minimize risk of hyponatremia and seizures, administer no more than once every 24 hours or for more than 3 consecutive days. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours.
Intravenous dosage:
Adults: 0.3 mcg/kg/dose (Max: 20 mcg/dose) IV once. If used preoperatively, administer 30 minutes before surgery. Determine need for repeat dosage based on laboratory response and patient's clinical condition. May repeat dose after 8 to 12 hours and once daily thereafter as needed to reduce spontaneous or traumatic bleeding. Guidelines recommend administering no more than once every 24 hours or for more than 3 consecutive days to minimize risk of hyponatremia and seizures. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours. The initial response is reproducible if desmopressin is given every 2 to 3 days.
Infants, Children, and Adolescents 3 months to 17 years: 0.3 mcg/kg/dose (Max: 20 mcg/dose) IV once. If used preoperatively, administer 30 minutes before surgery. Determine need for repeat dosage based on laboratory response and patient's clinical condition. May repeat dose after 8 to 12 hours and once daily thereafter as needed to reduce spontaneous or traumatic bleeding. Guidelines recommend administering no more than once every 24 hours or for more than 3 consecutive days to minimize risk of hyponatremia and seizures. Tachyphylaxis may occur with repeated administration given more frequently than once every 48 hours. The initial response is reproducible if desmopressin is given every 2 to 3 days.
For the management of sickle cell disease*:
Intravenous or Subcutaneous dosage:
Adults: Off-label use not recommended and not supported due to lack of evidence showing benefit over standard management, and also due to the extra monitoring costs and care in fluid management that are required to avoid adverse effects. A small series of patients with painful crisis were treated with desmopressin (0.3 mcg/kg IV/subcutaneous) in combination with high fluid intake to induce hyponatremia. Authors suggest that chronic hyponatremia (serum sodium 120 to 125 mmol/L) reduce the frequency of painful crisis, while acute hyponatremia abbreviated the duration of crisis. However, further case studies have not supported the use of desmopressin for the management of sickle cell crisis, mostly due to the difficulty in maintaining aggressive fluid intake.
For the treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void:
Intranasal dosage (Noctiva nasal spray, solution):
Adults 49 years and younger: Desmopressin nasal spray has not been studied in patients less than 50 years of age.
Adults 50 to 64 years: PATIENTS NOT AT INCREASED RISK FOR HYPONATREMIA: 1 spray (1.66 mcg) in either the left or right nostril approximately 30 minutes before going to bed. THOSE AT INCREASED RISK FOR HYPONATREMIA: 1 spray (0.83 mcg) in either the left or right nostril approximately 30 minutes before going to bed. After at least 7 days of treatment, the dose may be increased to 1.66 mcg, if needed, provided the serum sodium is within the normal range during treatment with the 0.83 mcg dose. The 0.83 mcg dose did not meet all prespecified efficacy endpoints in clinical trials, but may have a lower risk of hyponatremia.
Geriatric Adults: The recommended starting dose is 1 spray (0.83 mcg) in either the left or right nostril approximately 30 minutes before going to bed. After at least 7 days of treatment, the dose may be increased to 1.66 mcg, if needed, provided the serum sodium is within the normal range during treatment with the 0.83 mcg dose. The 0.83 mcg dose did not meet all prespecified efficacy endpoints in clinical trials, but may have a lower risk of hyponatremia.
Sublingual dosage (Nocdurna sublingual tablet):
Adult Females: 27.7 mcg sublingually once daily, 1 hour before bedtime without water. Only start or resume therapy in patients with a normal serum sodium concentration. The recommended dose for women is lower than for men because women are more sensitive to the effects of desmopressin sublingual tablet and had a higher risk of hyponatremia with the 55.3 mcg dose in clinical trials.
Adult Males: 55.3 mcg sublingually once daily, 1 hour before bedtime without water. Only start or resume therapy in patients with a normal serum sodium concentration.
For the treatment of symptomatic hyponatremia* or hyponatremia overcorrection*:
-for the treatment of symptomatic hyponatremia*:
Intravenous dosage:
Adults: 1 to 2 mcg IV every 6 to 8 hours in combination with hypertonic saline. Guidelines describe preemptive desmopressin administration to prevent sodium overcorrection.
-for the management of hyponatremia overcorrection in chronic hyponatremia*:
Intravenous dosage:
Adults: 2 to 4 mcg IV every 8 hours.
For the treatment of uremic bleeding*:
Intravenous or Subcutaneous dosage:
Adults: 0.3 to 0.4 mcg/kg/dose IV or subcutaneously once. Repeat dosing is not recommended due to tachyphylaxis.
Maximum Dosage Limits:
-Adults
Dependent on route of administration and indication for therapy.
-Geriatric
Dependent on route of administration and indication for therapy.
-Adolescents
Dependent on route of administration and indication for therapy.
-Children
Dependent on route of administration and indication for therapy.
-Infants
3 months and older: Dependent on route of administration and indication for therapy.
Less than 3 months: Safety and efficacy have not been established.
Patients with Hepatic Impairment Dosing
No dosage adjustments are needed.
Patients with Renal Impairment Dosing
CrCl 50 mL/minute or more: No dosage adjustment is needed.
CrCl less than 50 mL/minute OR eGFR less than 50 mL/minute/1.73 m2: Use is contraindicated. Single-dose administration has been used for uremic bleeding in patients with renal failure; however, repeat doses are not recommended.
*non-FDA-approved indication
Acetaminophen; Caffeine; Dihydrocodeine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Acetaminophen; Codeine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Acetaminophen; Guaifenesin; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Acetaminophen; Hydrocodone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Acetaminophen; Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Acetaminophen; Oxycodone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Acetaminophen; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Albuterol; Budesonide: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Alfentanil: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Amitriptyline: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Amlodipine; Celecoxib: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Articaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Caution should be used when coadministering these agents.
Aspirin, ASA; Carisoprodol; Codeine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Aspirin, ASA; Oxycodone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Atenolol; Chlorthalidone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Azelastine; Fluticasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Azilsartan; Chlorthalidone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Beclomethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Belladonna; Opium: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Benzhydrocodone; Acetaminophen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Betamethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Brompheniramine; Dextromethorphan; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Brompheniramine; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Budesonide: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Budesonide; Formoterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Budesonide; Glycopyrrolate; Formoterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Bumetanide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia.
Bupivacaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Caution should be used when coadministering these agents.
Bupivacaine; Meloxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Butalbital; Acetaminophen; Caffeine; Codeine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Butalbital; Aspirin; Caffeine; Codeine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Carbamazepine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including carbamazepine. The administration of carbamazepine prior to administration of desmopressin may act to reduce the duration of action of desmopressin. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Celecoxib: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Celecoxib; Tramadol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia. (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Chlordiazepoxide; Amitriptyline: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Chlorothiazide: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Chlorpheniramine; Codeine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Chlorpheniramine; Hydrocodone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Chlorpheniramine; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Chlorpromazine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including chlorpromazine. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Chlorthalidone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Ciclesonide: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Cisplatin: (Moderate) Frequently monitor serum sodium levels if concurrent use of desmopressin and cisplatin is necessary. Cisplatin can cause hyponatremia, which may increase the risk of water intoxication in patients receiving treatment with desmopressin.
Citalopram: (Minor) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including SSRIs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia, which may include monitoring serum sodium or electrolytes periodically. Ensure the patient is compliant with fluid restrictions and intake.
Clomipramine: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Codeine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Codeine; Guaifenesin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Codeine; Guaifenesin; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Codeine; Phenylephrine; Promethazine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Codeine; Promethazine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Corticosteroids: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Cortisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Deflazacort: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Demeclocycline: (Major) The antidiuretic response to desmopressin or vasopressin (ADH) may be reduced in patients concomitantly receiving demeclocycline. Caution should be used when coadministering these agents.
Desipramine: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Dexamethasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Dextromethorphan; Diphenhydramine; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Diclofenac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Diclofenac; Misoprostol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Diflunisal: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Diphenhydramine; Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Diphenhydramine; Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Diphenhydramine; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Dopamine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like dopamine only with careful patient monitoring.
Doxepin: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Caution should be used when coadministering these agents.
Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Escitalopram: (Minor) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including SSRIs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia, which may include monitoring serum sodium or electrolytes periodically. Ensure the patient is compliant with fluid restrictions and intake.
Ethacrynic Acid: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia.
Etodolac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Fenoprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Fentanyl: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Fludrocortisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Flunisolide: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Fluoxetine: (Minor) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including SSRIs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia, which may include monitoring serum sodium or electrolytes periodically. Ensure the patient is compliant with fluid restrictions and intake.
Flurbiprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Fluticasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Fluticasone; Salmeterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Fluticasone; Umeclidinium; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Fluticasone; Vilanterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Fluvoxamine: (Minor) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including SSRIs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia, which may include monitoring serum sodium or electrolytes periodically. Ensure the patient is compliant with fluid restrictions and intake.
Formoterol; Mometasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Furosemide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia.
Guaifenesin; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Heparin: (Minor) Desmopressin has been shown to have an additive effect on the anticoagulant activity of heparin. Caution should be used when coadministering these agents.
Homatropine; Hydrocodone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Hydrocodone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Hydrocodone; Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia. (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Hydrocortisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Hydromorphone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Ibuprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Ibuprofen; Famotidine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Ibuprofen; Oxycodone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia. (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Ibuprofen; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Imipramine: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Indomethacin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Isocarboxazid: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia and SIADH including monoamine oxidase inhibitors (MAOIs). Use combination with caution and monitor patients for signs and symptoms of hyponatremia, which may include seizures.
Ketoprofen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Ketorolac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Lamotrigine: (Major) Caution is recommended if a drug that may increase the risk of water intoxication with hyponatremia, such as lamotrigine, is administered with desmopressin acetate. Two children with diabetes insipidus had decreasing desmopressin requirements with lamotrigine initiation.
Levorphanol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Lidocaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Caution should be used when coadministering these agents.
Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Lithium: (Moderate) The antidiuretic response to desmopressin may be reduced in patients receiving lithium concomitantly. Caution should be used when coadministering these agents.
Loop diuretics: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia.
Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Meclofenamate Sodium: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Mefenamic Acid: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Meloxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Meperidine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Methadone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Methylprednisolone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Metolazone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Mometasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Monoamine oxidase inhibitors: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia and SIADH including monoamine oxidase inhibitors (MAOIs). Use combination with caution and monitor patients for signs and symptoms of hyponatremia, which may include seizures.
Morphine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Morphine; Naltrexone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Nabumetone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Naproxen; Esomeprazole: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Naproxen; Pseudoephedrine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Nonsteroidal antiinflammatory drugs: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Nortriptyline: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Olanzapine; Fluoxetine: (Minor) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including SSRIs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia, which may include monitoring serum sodium or electrolytes periodically. Ensure the patient is compliant with fluid restrictions and intake.
Oliceridine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Olopatadine; Mometasone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Opiate Agonists: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Oxaprozin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Oxybutynin: (Major) Hyponatremia-induced convulsions have been rarely reported when oxybutynin and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Oxycodone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Oxymorphone: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Paroxetine: (Minor) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including SSRIs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia, which may include monitoring serum sodium or electrolytes periodically. Ensure the patient is compliant with fluid restrictions and intake.
Perphenazine; Amitriptyline: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Phenelzine: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia and SIADH including monoamine oxidase inhibitors (MAOIs). Use combination with caution and monitor patients for signs and symptoms of hyponatremia, which may include seizures.
Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Piroxicam: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Prednisolone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Prednisone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Prilocaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Caution should be used when coadministering these agents.
Promethazine; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring.
Protriptyline: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Remifentanil: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Selective serotonin reuptake inhibitors: (Minor) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including SSRIs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia, which may include monitoring serum sodium or electrolytes periodically. Ensure the patient is compliant with fluid restrictions and intake.
Sertraline: (Minor) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including SSRIs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia, which may include monitoring serum sodium or electrolytes periodically. Ensure the patient is compliant with fluid restrictions and intake.
Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Sufentanil: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Sulindac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Sumatriptan; Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Tapentadol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Telmisartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Thiazide diuretics: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Tolmetin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. A woman who took both desmopressin and ibuprofen was found in a comatose state. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia.
Tolvaptan: (Major) Coadministration of tolvaptan and desmopressin (DDAVP) is not recommended. Tolvaptan is a V2 receptor antagonist and may interfere with the V2 agonist activity of DDAVP. In a male subject with mild Von Willebrand (vW) disease, intravenous infusion of DDAVP 2 hours after administration of oral tolvaptan did not produce the expected increases in vW Factor Antigen or Factor VIII activity.
Torsemide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia.
Tramadol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Tramadol; Acetaminophen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with water intoxication, hyponatremia, or SIADH including opiate agonists. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Tranylcypromine: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia and SIADH including monoamine oxidase inhibitors (MAOIs). Use combination with caution and monitor patients for signs and symptoms of hyponatremia, which may include seizures.
Triamcinolone: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Triamterene; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Tricyclic antidepressants: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Trimipramine: (Moderate) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including tricyclic antidepressants. Hyponatremia-induced convulsions have been rarely reported when imipramine and desmopressin are used concomitantly. Use these drugs together with caution, and monitor patients for signs and symptoms of hyponatremia.
Urea: (Minor) The manufacturer notes that the antidiuretic effect of desmopressin can be enhanced by the concomitant administration of urea. Dosage adjustments of desmopressin may be necessary to maintain proper sodium and water balance.
Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia.
Vasopressin, ADH: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like vasopressin, ADH only with careful patient monitoring.
Vincristine Liposomal: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including vincristine. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Vincristine: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with SIADH including vincristine. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia.
Desmopressin acts similarly to native vasopressin. Also known as antidiuretic hormone (ADH), vasopressin is secreted by the hypothalamus in response to hyperosmolarity, volume depletion, stress (emotional or physiological), certain drugs, and painful stimuli. Vasopressin also causes constriction of vascular smooth muscle and contraction of smooth muscle in the GI tract and uterus. Response to vasopressin is mediated through two receptors: the V1 receptor, which mediates smooth muscle contraction in the peripheral vasculature, and the V2 receptor, which regulates water resorption in the collecting ducts. Desmopressin is a strong V2 agonist and has no effect on V1 receptors. Desmopressin has slight structural variations that reduce its affinity for V1 receptors and lessen its vasopressin activity and contractile action on visceral smooth muscle. In contrast to vasopressin, desmopressin does not induce the release of adrenocorticotropic hormone or increase plasma cortisol concentrations. When administered to patients with central diabetes insipidus, desmopressin exerts antidiuretic effects similar to those of vasopressin; a reduction in urine output with an accompanying increase in urine osmolality and a decrease in clinical symptoms of urinary frequency and nocturia are noted following desmopressin treatment. Serum concentrations of potassium, sodium, and creatinine do not change following the administration of desmopressin, and urinary excretion of potassium and sodium also remains the same.
Desmopressin increases plasma factor VIII (FVIII) and von Willebrand factor (vWF) to a greater extent than equivalent weights of vasopressin. The hemostatic effects of desmopressin are mediated through V2 receptor agonist activity, as patients with nephrogenic diabetes insipidus, who lack this receptor, do not have a hemostatic response to desmopressin. It is postulated that desmopressin-induced increases in FVIII and vWF are mediated through low-affinity, extrarenal V2 receptors. Proposed sites of these receptors include endothelial cells, megakaryocytes, blood monocytes, and mast cells. The resultant increases in FVIII and vWF are similar to those seen with replacement therapy using blood products. Increased FVIII and vWF levels are thought to be due to their release from endogenous reservoirs and not increased synthesis since the response is so rapid. Desmopressin has also been used in congenital or acquired bleeding disorders, including drug-induced platelet dysfunction (e.g., aspirin, dextran, ticlopidine, and heparin). The presence of platelet-vWF and normally functioning platelet glycoprotein (GP) IIb/IIIa seem to be essential for desmopressin's effect on platelets. Desmopressin may promote an increased exposure of platelet vWF to GPIIb/IIIa on the platelet surface upon activation of the platelet. Levels of FVIII are also increased, which increases hemostasis by accelerating fibrin formation. Plasminogen activator activity increases after intravenous desmopressin, but clinically significant fibrinolysis has not been detected in patients treated with desmopressin.
Desmopressin is administered orally, intranasally, or parenterally (intravenous or subcutaneously). The distribution of the drug is unknown, and it is not clear whether desmopressin crosses the placenta. Desmopressin is found in breast milk, but not in significant amounts. It is not known if the drug is metabolized; however, in contrast to vasopressin, desmopressin does not appear to be degraded by the peptidase enzymes responsible for metabolizing endogenous vasopressin during the last trimester of pregnancy. Desmopressin is primarily excreted in the urine, with a significant portion excreted as unchanged drug (65% after oral and 92% after intranasal administration). Following an intranasal dose of 1.66 mcg of desmopressin for nocturia, the median apparent terminal half-life was 2.8 hours; the half-life range in patients with an eGFR above 50 mL/minute/1.73 m2 was 1.4 to 3.8 hours.
-Route-Specific Pharmacokinetics
Oral Route
Following oral administration, the bioavailability of desmopressin is about 5% and 0.16% compared to intranasal and intravenous administration, respectively. The time to reach maximum plasma desmopressin levels is 0.9 hours. Following oral administration, the onset of antidiuretic effect occurs around 1 hour and reaches a maximum at 4 to 7 hours. Oral doses of 0.2 and 0.4 mg produce similar responses on urine volume and urine osmolality as 0.01 mg and 0.02 mg intranasal doses. However, individualized dosing is recommended due to high inter-patient variability in response. Following oral administration, the half-life of desmopressin is about 1.5 to 2.5 hours and is independent of dosage.
Intravenous Route
Maximal dose-response increase in Factor VIII activity occurs at 0.3 to 0.4 mcg/kg desmopressin. This increase is dose-dependent, with an IV dosage of 0.4 mcg/kg producing a 300% to 400% maximum increase in Factor VIII activity. There is no increase in activity with doses greater than 0.4 mcg/kg, despite increases in desmopressin concentrations. This is probably due to saturation of receptor sites. Increased Factor VIII activity is noted 30 minutes after IV administration, with peak activity occurring in 90 minutes to 2 hours. The initial and terminal half-lives for desmopressin are 7.8 and 75.5 minutes, respectively, resulting in a prompt onset of action with a long duration of action. Other evaluations have indicated that the terminal half-life for desmopressin is approximately 3 hours.
Other Route(s)
Intranasal Route
Approximately 3% to 4% of an intranasally administered dose is absorbed across the nasal mucosa. Intranasal desmopressin has an antidiuretic effect of about one-tenth that of an equivalent dose administered by injection. Peak plasma concentrations are noted within 40 to 45 minutes of a dose. Antidiuretic effects usually occur within 15 to 60 minutes, with peak effects evident 1 to 5 hours after nasal administration. The antidiuretic effects of the drug last for about 5 to 21 hours, followed by an abrupt cessation of activity that occurs over a 60- to 90-minute period. Increased Factor VIII activity is noted 30 minutes after intranasal administration, with peak activity occurring in 90 minutes to 2 hours. Intranasal desmopressin 300 mcg results in maximal Factor VIII and von Willebrand Factor activity levels 150% to 250% of normal. After a 300 mcg intranasal dose of desmopressin levels of Factor VIII and vWF remain greater than 30 units/dL for 8 hours. The initial and terminal half-lives for desmopressin are 7.8 and 75.5 minutes, respectively, resulting in a prompt onset of action with a long duration of action. Following administration of intranasal desmopressin for nocturia, the median time to peak plasma concentrations (Tmax) was 0.25 hour for the 0.83 mcg dose and 0.75 hour for the 1.66 mcg dose. The mean (+/- S.D.) peak plasma concentration (Cmax) was 4 (+/- 3.85) pg/mL for the 0.83 mcg dose and 9.11 (+/- 6.90) pg/mL for the 1.66 mcg dose. The plasma concentrations generally declined below 2 pg/mL (lower limit of quantitation) 4 to 6 hours post-dose.
-Special Populations
Renal Impairment
In patients with renal impairment receiving single doses of desmopressin injection, the terminal half-life was significantly increased from a mean of 3.4 hours in healthy patients to a mean of 7.2 hours in patients with moderate renal impairment (mean CrCl 37 mL/minute, range 29 to 54 mL/min) and 10 hours in patients with severe renal impairment (mean CrCl 16 mL/minute, range 10 to 26 mL/minute). The pharmacokinetics of intranasal desmopressin for nocturia were evaluated in 8 renally impaired patients with an eGFR less than 50 mL/minute/1.73 m2, matched to 8 patients with an eGFR greater than 50 mL/minute/1.73 m2. The AUC and half-life of desmopressin were approximately 3 to 4 fold higher for the group with eGFR below 50 mL/minute/1.73 m2. The use of desmopressin is contraindicated in patients with moderate to severe renal impairment (CrCl less than 50 mL/min) or eGFR below 50 mL/minute/1.73 m2.
Geriatric
In patients receiving desmopressin for nocturia, there were no significant differences in systemic exposure (AUC and Cmax) with respect to age among subjects 50 years and older. Studies of desmopressin for all other indications did not include sufficient numbers of subjects aged 65 and over to determine differences vs. younger subjects.
Gender Differences
In patients receiving intranasal desmopressin for nocturia, there were no significant differences in systemic exposure (AUC and Cmax) with respect to gender.