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Had diabetes, having incontinence, treated with desmopressin. What medicine and dosage can be taken?

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Have had diabetes insipidus for several years.
Incontinence day and night. Being treated with
Desmopressin Nasal Spray. One spray in one
Nostril am and pm. Feel I need stronger
Dosage as still some leakage. What do you
Think? Also would like to take pills instead of
Nasal spray as I am going on a long trip and
Spray must be refrigerated. Is that a reasonable
Posted Wed, 19 Jun 2013 in Medicines and Side Effects
Answered by Dr. Omer 1 hour later

I am Dr.Omer and I am here to help with your query

As you have said that you are having diabetes insipidus , taking DDAVP nasal spray , still mild day time incontinence , and need to shift over to oral form from liquid form , as you are proceeding on vacation

There are three major therapeutic options for Diabetes insipidus(DI):

1. a low solute (sodium/salt and protein) diet
2. desmopressin (dDAVP), an ADH analog
3. other drugs, including thiazide diuretics, carbamazepine, NSAIDS (pain killers)
4. Fluid restriction should be observed.

Desmopressin can be administered intranasally, orally, subcutaneously, or intravenously. The intranasal preparation should be used initially as not all patients respond to oral therapy.

The intranasal preparation can be blown into the nose with a curved, dose-calibrated small plastic tube or delivered with a nasal spray.

An initial dose can be titrated upward in increments depending upon the response of the nocturia(night time urine) and then additional daytime doses added if there is any incontinence.

The desmopressin metered spray bottle is currently used more commonly than the rhinal tube because of greater convenience of administration as metered spray bottle gives the minimum dose is 10 microg

The absorption of oral desmopressin in normal persons is decreased by 40 to 50 percent when taken with meals.

This usually has little effect on the antidiuretic action but administering the drug in the fasting state may be tried if there is a poor response to the usual doses taken with meals.

The oral form has about one-tenth to one-twentieth the potency of the nasal form because only about 5 percent is absorbed from the gut.

Thus, a 0.1 mg tablet is the equivalent of 2.5 to 5 microg of the nasal spray.

However, because the oral dose cannot be precisely predicted from a previous nasal dose, transfer of patients from nasal insufflation to oral therapy usually requires some dosage retitration.

The initial dose of the tablet form is 0.05 mg (one-half a 0.1 mg tablet) at bedtime with titration as with the liquid form.

The usual daily maintenance dose of tablet form ranges from 0.1 mg to 0.8 mg in divided doses but may be as high as 1.2 mg/day.

Carbamazepine or clofibrate appears to enhance the response to ADH , whereas clofibrate may increase ADH release and can lower the urine output by as much as 50 to 60 percent

Thiazide diuretics causes induction of mild volume depletion with a low salt diet and can reduce the urine output by more than 50 percent, from 10 L/day to below 3.5 L/day

Treatment with an NSAID(pain killers) increases the antidiuretic effect of any dose of ADH. The net effect in patients with DI may be a 25 to 50 percent reduction in urine output

Desmopressin can lead to water retention and low sodium if the urine is concentrated for most of the day. This can usually be avoided by giving the minimum required dose to control the polyuria(high urination) and not administering another dose until the patient has had a period of brisk diuresis(high urine), indicating that the effect of the previous dose of desmopressin had waned and hence preventing Tachyphylaxis

Desmopressin is famous for tachyphylaxis , meaning the effect of DDAVP is decreased with time due to receptor of your body where DDAVP has to bind , disappears.

The serum sodium concentration should be checked at 24 hours after the initiation of desmopressin therapy and with change over to oral form and you should know the symptoms that may be induced by hyponatremia. These include nausea, vomiting, headache, lethargy. If that occurs , GO TO ER.

Intranasally Antidiuretic effect starts in 15-30 minutes , with Peak effect of Antidiuretic is 1 hour

Oral tablet has start of Antidiuretic effect in 1 hour , with Peak effect seen in 4-7 hours

Bioavailability in your body: Intranasal: ~3.5%; Oral tablet: 5% compared to intranasal

So keeping in view of above the summary is you may be shifted over to tablet form , with simultaneous /occasional use of Intranasal spray during your vacation , titer the tablet according to your urine output , as you will need adjusment of dose when on oral form , and day time incontinence can be decreased by avoiding Tachyphylaxis and increasing the dose.

Hope this fully explains your query

Let me know if you need any further clarifications

Happy Vacations

Take care
Above answer was peer-reviewed by
Follow-up: Had diabetes, having incontinence, treated with desmopressin. What medicine and dosage can be taken? 2 hours later
I don't understand how to adjust the dose when on an oral form. Is it possible to transport the nasal spray in an ice protected container? I will be in a hotel so I can get ice if you think that will protect it. I still think I need a stronger dosage of the nasal spray as I have leakage still. I think .1 mg in one nostril is too small day and night. What do you think?

Answered by Dr. Omer 53 minutes later

I will make it easy for you to understand.

You are currently taking desmopressin nasal spray ( one spray in one nostril in morning and one spray in other nostril at night).

One spray (10 mcg ) = 0.2mg of oral desmopressin

So your exact dose will be tablet desmopressin 0.2mg in morning and 0.2 mg before bedtime(0.2+0.2)

Titrate the dose but I would not recommend for you to go beyond 0.4mg per day

Since the oral absorption of desmopressin is poor i would suggest to take your desmopressin nasal spray with you (see manufacturers detail for drug transport).

Store DDAVP® and Stimate® at room temperature. Keep upright. Throw away any part not used after 6 months.

Store DDAVP® Rhinal Tube and Minirin™ in a refrigerator or at room temperature. If stored at room temperature, throw away any part not used after 3 weeks

So you dont need any ice , refrigrator if the temperature of the place you are going is between 25*c---30*c

I hope this explain your question and relieves your tension.

Feel free to ask any further questions.

Take care,

Above answer was peer-reviewed by
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