desmopressin
Regulatory sources consulted
Approved indications
- Central diabetes insipidus and primary nocturnal enuresis from age 5 years with normal urine-concentrating capacity.
Contraindications
Absolute
- Habitual or psychogenic polydipsia, heart failure or need for diuretics, creatinine clearance <50 mL/min, hyponatremia, SIADH, or hypersensitivity.
Clinical warnings
- Major warning · May cause fluid retention and hyponatremia with seizures, cerebral edema, or coma. For enuresis, restrict fluids from 1 hour before until at least 8 hours after dosing; stop during fever, vomiting, diarrhea, or fluid/electrolyte imbalance. — CIMA/AEMPS, ficha técnica 89016
- Major warning · In older adults, check sodium before treatment, at day 3, and after each increase; do not start with hyponatremia. Restart after hyponatremia only with strict fluid restriction and monitoring. — CIMA/AEMPS, ficha técnica 89016
Drug interactions
- HighSIADH-inducing drugs or NSAIDs
Mechanism: They may increase antidiuretic effect and the risk of fluid retention and hyponatremia.
Recommendation: Strengthen fluid restriction and measure sodium more frequently.
CIMA/AEMPS, ficha técnica 89016https://cima.aemps.es/cima/dochtml/ft/89016/FT_89016.html
- HighLoperamide or other drugs that slow intestinal transit
Mechanism: Loperamide may triple desmopressin exposure.
Recommendation: Avoid or closely monitor fluid retention and sodium.
CIMA/AEMPS, ficha técnica 89016https://cima.aemps.es/cima/dochtml/ft/89016/FT_89016.html
Adverse events
Common (≥1%)
Headache · Nausea or abdominal pain · Dizziness · Weight gain · Edema
Rare but serious
Severe hyponatremia · Seizures or coma · Cerebral edema · Anaphylactic reaction
Pregnancy and lactation
Use cautiously during pregnancy and monitor blood pressure. It may be used while breastfeeding; the amount entering milk is far below that needed to affect diuresis.