Slideshow 10 Common Sleep Disorders: The biphasic half-lives for intranasal desmopressin acetate were 7. As a result, intranasal desmopressin acetate provides a prompt onset of antidiuretic action with a long duration after each administration. The change in structure of arginine vasopressin to desmopressin acetate has resulted in a decreased vasopressor action and decreased actions on visceral smooth muscle relative to the enhanced antidiuretic activity, so that clinically effective antidiuretic doses are usually below threshold levels for effects on vascular or visceral smooth muscle.
Desmopressin acetate administered intranasally has an antidiuretic effect about one-tenth that of an equivalent dose administered by injection. Desmopressin acetate is mainly excreted in the urine. It is ineffective for the treatment of nephrogenic diabetes insipidus. The use of desmopressin acetate nasal solution 0. This will allow the resumption of a more normal life-style with a decrease in urinary frequency and nocturia. There are reports of an occasional change in response with time, usually greater than 6 months.
Some patients may show a decreased responsiveness, others a shortened duration of effect. There is no evidence this effect is due to the development of binding antibodies but may be due to a local inactivation of the peptide.
Continued response to intranasal desmopressin acetate can be monitored by urine volume and osmolality. Desmopressin acetate is also available as a solution for injection when the intranasal route may be compromised. These situations include nasal congestion and blockage, nasal discharge, atrophy of nasal mucosa, and severe atrophic rhinitis.
Intranasal delivery may also be inappropriate where there is an impaired level of consciousness. In addition, cranial surgical procedures, such as transsphenoidal hypophysectomy create situations where an alternative route of administration is needed as in cases of nasal packing or recovery from surgery.
Contraindications Desmopressin acetate nasal solution 0. Desmopressin acetate is contraindicated in patients with hyponatremia or a history of hyponatremia. Warnings For intranasal use only. Very rare cases of hyponatremia have been reported from world-wide postmarketing experience in patients treated with desmopressin acetate.
Unless properly diagnosed and treated hyponatremia can be fatal. Careful medical supervision is required. When desmopressin acetate nasal solution 0. All patients receiving desmopressin acetate therapy should be observed for the following signs or symptoms associated with hyponatremia: Severe symptoms may include one or a combination of the following: Particular attention should be paid to the possibility of the rare occurrence of an extreme decrease in plasma osmolality that may result in seizures which could lead to coma.
Desmopressin acetate should be used with caution in patients with habitual or psychogenic polydipsia who may be more likely to drink excessive amounts of water, putting them at greater risk of hyponatremia. Precautions General Intranasal desmopressin acetate at high dosage has infrequently produced a slight elevation of blood pressure, which disappeared with a reduction in dosage. Desmopressin acetate should be used with caution in patients with conditions associated with fluid and electrolyte imbalance, such as cystic fibrosis, heart failure and renal disorders because these patients are prone to hyponatremia.
Rare severe allergic reactions have been reported with desmopressin acetate. Anaphylaxis has been reported rarely with intravenous and intranasal administration of desmopressin acetate.
Central Cranial Diabetes Insipidus Since desmopressin acetate is used intranasally, changes in the nasal mucosa such as scarring, edema, or other disease may cause erratic, unreliable absorption in which case intranasal desmopressin acetate should not be used. For such situations, desmopressin acetate injection should be considered. Information for Patients Ensure that in children administration is under adult supervision in order to control the dose intake.
Patients should be informed that the desmopressin acetate nasal solution 0. Any solution remaining after 50 doses should be discarded since the amount delivered thereafter may be substantially less than 10 mcg of drug. Keep track of the number of sprays used from each container. Discard the container after you have used the number of sprays specified on the package. Consult your doctor for details. If you find that you are drinking more fluids than directed, tell your doctor right away.
Your treatment will need to be adjusted. See also Side Effects and Precautions sections. Do not use more desmopressin or use it more often than prescribed.
To help you remember, use it at the same time s each day. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Desmopressin can rarely cause a low level of sodium in the blood, which can be serious and possibly life-threatening. Drinking too much water or other fluids increases the risk of having a low level of sodium in the blood. Therefore, follow your doctor's directions for limiting fluids. Seek immediate medical attention if you have any of these unlikely but serious symptoms of a low level of sodium in the blood: However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: This is not a complete list of possible side effects.
If you notice other effects not listed above, contact your doctor or pharmacist. Call your doctor for medical advice about side effects. In Canada - Call your doctor for medical advice about side effects.
You may report side effects to Health Canada at If you use 1 dose daily and miss a dose, use it as soon as you remember. If you do not remember until the next day, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up. If you use more than 1 dose daily and miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Drug interactions may change how your medications work or increase your risk for serious side effects.
This document does not contain all possible drug interactions. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
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