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Have diabetes insipidus and caused incontinence. Prescribed desmopressin Nasal spray. Having leakage, suggest dosage?

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Practicing since : 2001
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I have diabetes insipidus and this has caused a lot of incontinence problems for several years. An endocrinologist prescribed Desmopressin Nasal Spray - once in morning and once at night - just one nostril each time. I don't feel this is enough because of leakage. Also would like pills, which she says are less effective. I am going on a trip across country and nasal spray has to be kept refrigerated. How do I do that and keep it cold in hotel? is it a reasonable request to ask for pills?
Posted Thu, 20 Jun 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 19 hours later
Yes, desmopressin is available in the form of tablets. Historically the nasal spray has been used effectively and many endocrinologists have years of experience doing this. And hence there is a certain degree of comfort and confidence in prescribing the spray. This is particularly important for doctors and patients when using a potent medication like desmopressin which if inadvertently overdosed can have potentially life threatening consequences. A low blood sodium level can result if excessive desmopressin is taken. I see you already on two water pills that can potentially lower blood sodium.
But to categorically answer your question, yes.....pills are a viable form of treatment option.
Regardless, fluid intake and blood sodium levels will need to be monitored carefully and closely during transition from spray to pills to arrive at the steady dose requirement.
I see you mention 'leakage'. I would like to note that diabetes insipidus, if untreated or under-treated (with insufficient desmopressin dose) typically causes large amounts of urine to be passed and often in compensation , affected individuals drink a lot of water, provided their thirst sensation is intact and they have access to water. However, there is no true 'incontinence'
Please kindly check with the pharmacist or manufacturer for storage guidance on individual brands of desmopressin spray
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