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DESMOPRESSIN (MINIRIN) - a patient's guide
Natalie Gauld - Pharmacy Educator
USE: Bedwetting (nocturnal enuresis), central diabetes
insipidus (not sugar diabetes), testing kidney function
(the capacity to concentrate urine), some blood disorders.
Desmopressin works like vasopressin (a natural hormone
in the body) to allow the body to reabsorb water from the
kidneys which increases the concentration of the urine and
reduces the quantity of urine. Therefore, the need to use
the toilet (urinate) is reduced. Desmopressin can be used
for a short time in bedwetting in children over 5 years
of age. It is also used in cases where the body is not reabsorbing
enough liquid from the kidneys.
The usual dose for children for bedwetting is 10 to 40
mcg (one to four puffs of the spray) into the nose at night,
and it lasts for 8 hours or more. If using 10 mcg this is
just one puff into one nostril only (for this nose spray
you do not have to use the same dose in both nostrils).
This dose may be varied by the doctor to give best effect.
For central diabetes insipidus the usual dose is 20 to
40 mcg (two to four puffs of the spray) and children 10
to 20 mcg (one to two puffs of the spray) either given in
a single dose or divided into two or three doses - according
to the needs of the individual.
Minirin comes in nose spray, nose drops and tablets. In
New Zealand the tablets aren't "free" on prescription and
require many times more medicine for the same effect as
the nose spray or drops because much of the medicine is
destroyed in the stomach and intestines. Octostim also contains
desmopressin but is much stronger for control of bleeding
under a doctor's supervision, and must not be used in place
of Minirin.
Cautions:
Do not use if:
Excessive quantities of water are being taken all the
time
Diuretics are being taken
You are allergic to the ingredients (chlorobutanol is
the preservative in the formulation available in New Zealand)
If any of the following factors are present the doctor
may not want to use this medicine, or may want to take special
care:
Young or elderly patients
Imbalance of fluid and/or electrolytes (e.g. dehydration,
or potassium or sodium not the right concentration in the
body)
Use of diuretics (fluid pills)
If there is a risk of increased intracranial pressure
If there are nose problems which might affect the medicine
going into the blood stream, e.g. scarring inside the nose.
Side effects:
When used into the nose possible side effects include
local irritation, congestion and nosebleed.
As this medicine causes increased water to be reabsorbed
from the kidneys, use with other medicines which also have
this same effect can increase the risk of water intoxication
(too much water in the body) or low sodium in the bloodstream,
e.g. tricyclic antidepressants, carbamazepine, chlorpromazine,
fludrocortisone. The risk of water intoxication or low sodium
can be reduced by avoiding these medicines, avoiding drinking
too much (just enough to satisfy thirst) for 1 hour before
and 8 hours after using, and using only the recommended
dose.
Other possible side effects include headache, stomach
pain and nausea.
Interactions:
As this medicine causes increased water to be reabsorbed
from the kidneys, use with other medicines which also have
this same effect can increase the risk of water intoxication
(too much water in the body) or low sodium in the bloodstream,
e.g. tricyclic antidepressants, carbamazepine, chlorpromazine,
and fludrocortisone.
Patient information:
Follow the instructions on the label of the medicine or
as directed by your doctor.
Store the nose spray and nose drops in the fridge.
Do not give this medicine to anyone else. If two people
in the family are prescribed it, make sure they use only
their own nasal spray - it is not a good idea to swap nose
sprays.
If taking for bedwetting drink a minimum of fluid (just
enough to satisfy thirst) from 1 hour before to 8 hours
after using the nose spray or drops.
Usually there will be a one week period without using
desmopressin after three months to decide whether the medicine
is still required (bedwetting only).
If vomiting or diarrhoea occur check with your doctor
or pharmacist whether you should use this medicine while
sick (you may need to stop it temporarily).
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