Desmopressin (nasal route)

Desmopressin is a nasal spray that is used to treat patients who are suffering from a condition called central cranial diabetes insipidus, which causes dehydration. The condition can be caused by injuries to the brain and sometimes by surgical procedures involving the brain.

Overview

Desmopressin is a drug that is used to treat patients who are suffering from a condition called central cranial diabetes insipidus. This health condition causes the sufferer to lose too much fluid, resulting in dehydration. Some forms of brain surgery or brain injury causes increased thirst and frequent urination, and desmopressin is also used to help control this. The Stimate® nasal spray form of desmopressin is used to tackle bleeding in people who are suffering from illnesses such as von Willebrand disease (Type 1) and hemophilia A.

In children, desmopressin can also be used to help control night time bedwetting.

Desmopressin replicates the natural substance, vasopressin that works by acting on the patient’s kidneys to lessen the production and flow or urine. When used to control bleeding, desmopressin works by increasing the blood amounts of von Willebrand factor and factor VIII in patients who are deficient in these factors.

In the US, desmopressin is branded as DDAVP, DDAVP Rhinal Tube, Stimate, and Minirin. It is available as a solution or nasal spray and is only available from your doctor with a prescription.

Conditions treated

• cranial diabetes insipidus
• deficiency in von Willebrand factor and factor VIII

Type of medicine

• vasopressin replacement
• nasal spray
• solution

Side-effects

Together with the effects, it is intended to have, desmopressin can sometimes cause a few unwanted side effects. Not all of the effects mentioned here will affect you, but if they do, you should speak with your treating physician.

If any of the following effects manifest themselves, you should check with your GP straight away:

• tightness of the chest
• swollen hands, face, or ankles
• swollen eyelids, or puffiness around the eyes
• rapid, pounding, irregular, or racing pulse or heartbeat
• nausea or vomiting
• muscle cramp or pain
• increased thirst
• hives, skin rash, or itching
• headache
• fever
• feeling unusually tired or weak
• drowsiness
• dizziness
• difficulty swallowing
• decreased urine output
• cough
• convulsions
• confusion
• chills
• chest pain
• breathing problems

There are a few side effects caused by desmopressin that will resolve themselves without the need for more medical treatment as your body adjusts to the medicine. Your GP could also be able to give you some advice on how to manage or prevent these effects. If you find that the unwanted effects persist or become especially annoying, check with your GP.

• stuffy or runny nose
• sneezing
• nosebleeds
• itchy, burning, or dry eyes
• diarrhea
• excessive tearing, or eye discharge
• indigestion
• poor appetite
• flatulence
• redness or itching of the eye
• stomach pain, feeling bloated or in discomfort
• stomach or abdominal cramps
• sour or acid stomach
• belching
• feeling very warm
• headache
• heartburn
• redness of the arms, neck, face, and upper chest
• unusual sleepiness or drowsiness
• insomnia

Some people experience other effects that may not be mentioned here. If you notice any other odd effects, you should speak with your doctor. Similarly, if you begin to feel worse or if you are not convinced that your condition is showing signs of improvement, you should check with your GP.

Dosage

You should only use your supply of desmopressin nasal spray as you have been told to by your treating physician. You should not take more of the medicine than you have been told to. Do not take desmopressin longer than your GP advised.

When you are dispensed this medicine by your pharmacist, you will also receive some instructions, explaining how to use it. If you do not understand these guidelines, ask your pharmacist or your GP for clarification.

You must only use desmopressin in your nose; it is not to be taken orally.

Your treating physician may recommend that you restrict your fluid intake. You must do this to avoid any unwanted effects.

Using desmopressin nasal spray

1. First of all, you must prime the spray. To do this, press the pump down four times. If you do not use your spray for more than a week, you will need to re-prime the pump by pressing it down just once.

2. Before you use the spray, blow your nose gently. Tip your head back and place the tip of the spray dispenser into one nostril.

3. Use your finger to close the other nostril. Administer one spray while breathing in gently.

4. Retain a breath for a few seconds, and then exhale slowly through your mouth.

5. If you need to use a second dose of desmopressin, repeat the process in the opposite nostril in the same way.

6. After using the spray, refrain from blowing your nose or tilting your head back.

7. Wipe around the tip of the spray bottle with a dry, clean tissue, and then put the cap back on firmly.

8. Discard any unused drug after 50 sprays with DDVAP® or desmopressin generic, or 25 sprays with Stimate®

Using DDAVP® Rhinal Tube

• The Rhinal tube comes with a flexible plastic applicator tube that has the dose shown numerically on it.

• To load the applicator with the correct dose, place the tip of the bottle into the end of the tube as per the indicator arrow.

• Place the arrowed end of the tube into one nostril. Put the other end of the tube into your mouth.

• Tilt back your head, hold your breath, and give one short blow into the tube until all the contents are sprayed into your nose.

• Try not to allow the drug to trickle into your throat.

• If giving the medicine to a child, an adult must blow into the tube to dispense the drug.

• After use, wash the tube with clean water. Shake the tube to clear away any residual water.

• Replace the seal on the container’s tip and put the plastic cap back on.

The dose of desmopressin that you are prescribed will vary between patients. You should follow your doctor’s instructions or those printed on the product packaging. The information given here is based on the average dose for this drug. If you have been given a different dose, you should not alter it until you are told to do so by your GP.

The dose you will take will be dependent of the potency of the preparation. In addition, the quantity of daily doses, the time you have to leave between using the drug, and the duration of your course of treatment with this drug will vary, depending on the health condition that you are being treated for.

For diabetes insipidus:

• Adults: Take 0.1 ml to 0.4 ml once daily or divided into up to three daily doses. You can take each dose in one nostril or both if you prefer. Your GP may alter the dose as required.

• Children from three months to 12 years old: Take 0.05 ml to 0.3 ml once daily or divided into two daily doses. You can take each dose in one nostril or both if you prefer. Your GP may alter the dose as required.

• Children under three months: Your child’s doctor will advise as to the dose and use of this drug.

For von Willebrand disease or hemophilia A:

• Adults and teens: Take 0.1 ml once daily. Your GP may alter the dose as required.

• Children from 11 months to 12 years old: Your child’s doctor will advise as to the dose and use of this drug.

This drug is not recommended for use in children under 11 months old.

If you forget a dose of desmopressin, try to administer it as soon as you can. If your next dose is nearly due, miss out the one you forgot and return to your usual dosing frequency. Do not use twice the amount.

Interactions

Some drugs should not be used together under any circumstances, as a dangerous interaction could occur. In other instances, it may be possible to use two medicines simultaneously, even though there may be an interaction between them. If this applies in your case, your doctor might elect to change the dose of one or both of your prescription medicines or advise you on some precautions that you can take to counteract or manage the side effects.

If you are taking any other prescription medicines or over the counter products, you must tell your GP before you begin using desmopressin. This list should include any vitamin supplements and herbal products.

You should refrain from eating, drinking alcohol, or using tobacco with some forms of medication as to do so can cause interactions to take place. It is important that you discuss this with your treating specialist before you start using desmopressin nasal spray.

Warnings

When you decide to use a medication, you should consider the risks as well as the benefits of doing so. Be sure to discuss the pros and cons of using desmopressin with your GP.

If you have ever noticed a bad reaction to this or any other form of prescription or non-prescription drug, tell your treating physician before beginning treatment with desmopressin nasal spray. You should also alert your GP to any allergies that you may have to certain types of foods, animal products, food preservatives, or food colors.

Stimate® should not be used in children under the age of 11 months for the treatment of von Willebrand disease or hemophilia A.

Desmopressin should be used with caution in elderly patients, because they are more likely to have kidney problems. This means that the drug may be slower to leave the person’s body, potentially increasing the risk of overdose.

There are no studies to indicate that desmopressin can be harmful to the fetus. However, you should tell your doctor if you are pregnant or considering becoming pregnant during the course of your treatment with desmopressin.

Studies have not shown that using desmopressin poses any risk to nursing infants. However, you may wish to use an alternative feeding method for your child while you are using desmopressin nasal spray.

Medical conditions

If you suffer from other health conditions, they may affect the use of desmopressin nasal spray. Be sure to discuss your medical history fully with your treating specialist before commencing treatment with this drug.

Although desmopressin nasal spray can be taken by patients with the following medical conditions, it should be used with caution, as it could make these problems worse:

• tachycardia
• hypotension
• hypertension
• blood clotting issues

The use of desmopressin with the following conditions could cause side effects to worsen:

• psychogenic or habitual polydipsia
• kidney disease
• heart failure
• cystic fibrosis
• coronary artery disease

Desmopressin should never be used in patients with any of the following conditions:

• low blood sodium (hyponatremia)
• severe or moderate kidney disease

Do not use Stimate® to treat patients with type IIB von Willebrand disease.

You must attend your doctor for regular progress checks while you are taking this drug. These visits allow your GP to carry out blood and urine tests to make sure that the medicine is working correctly, to adjust your dose if necessary, or to discontinue treatment when required.

Desmopressin reduces the quantity of sodium that is present in the blood. If you begin to experience any of the symptoms listed below, check with your GP immediately:

• vomiting
• nausea
• muscle spasms or cramps
• feeling unusually weak or tired
• confusion

In rare cases, desmopressin can cause a severe allergic reaction called anaphylaxis. If you begin to notice any of the following symptoms within a few minutes of using this drug, you should call 911 immediately. Do not delay seeking emergency attention; this condition can prove fatal if not treated promptly:

• swelling of throat, tongue, or face
• rash
• itching
• chest pains
• breathing difficulties

Unless you have discussed the matter with your doctor, do not take any other medicines, including vitamins, herbal remedies, or over the counter drugs while you are using desmopressin.

Storage

Keep your supply of desmopressin nasal spray in an upright position, away from sources of heat and out of direct sunlight. Store DDAVP® Rhinal Tube System nasal spray in your refrigerator. Alternatively, you can keep the medicine at room temperature for up to three weeks.

If you are prescribed Stimate®, you should keep your medication in an upright position and at room temperature. Once the bottle has been opened, it should be discarded after six months.

Do not use any medication that has passed its use-by date, or if the bottle appears to have been opened or damaged.

Keep the medicine out of reach of curious children and pets.

Dispose of any unwanted medicine responsibly. Do not pour the solution down the drain or toilet. Wrap it in a sealed bag and place it out of sight in your trash can.

Summary

Desmopressin is used to treat people who suffer from a condition called central cranial diabetes insipidus. This condition can cause the patient to excrete too much fluid, potentially causing dehydration. Brain surgery or brain injury can cause increased thirst and consequent frequent urination, and desmopressin is used to help control this. Certain forms of desmopressin are used to combat bleeding in people who are suffering from illnesses such as von Willebrand disease (Type 1) and hemophilia A. Sometimes, desmopressin is used to help prevent bedwetting in children.

Although there are few drugs that cannot be used at the same time as desmopressin, there are a number of medical conditions that can be made worse by the use of this medication. For these reasons, you should be sure to discuss your medical history fully with your treating specialist before you begin using desmopressin. You will also need to attend your doctor’s surgery for regular progress assessments to make sure that the drug is working as desired and that you are not suffering from any unpleasant side effects.