Chemical formula: C₄₆H₆₄N₁₄O₁₂S₂ Molecular mass: 1,069.22 g/mol
Desmopressin interacts in the following cases:
NSAIDs may induce water retention and/or hyponatraemia.
Substances which are known to induce SIADH e.g. tricyclic antidepressants, selective serotonin re-uptake inhibitors, chlorpromazine and carbamazepine, may cause an additive antidiuretic effect leading to an increased risk of water retention and/or hyponatraemia.
Glibenclamide and lithium may attenuate the antidiuretic effect of desmopressin.
Concomitant treatment with loperamide may result in a 3-fold increase of desmopressin plasma concentrations, which may lead to an increased risk of water retention and/or hyponatraemia. Although not investigated, other drugs slowing intestinal transport might have the same effect.
Precautions to prevent fluid overload must be taken in conditions characterised by fluid and/or electrolyte imbalance.
Care should be taken with patients who have cystic fibrosis.
Precautions to prevent fluid overload must be taken in patients at risk for increased intracranial pressure.
Desmopressin should be used with caution in patients with coronary heart disease, hypertension and severe hypertension.
There are no adequate and well-controlled studies in pregnant women. Published reports stress that, as opposed to preparations containing the natural hormone, desmopressin acetate in antidiuretic doses has no uterotonic action, but the physician will have to weigh the possible therapeutic advantage against potential danger in each case.
Reproduction studies performed in rats and rabbits have revealed no evidence of harm to the fetus due desmopressin acetate. Subcutaneous doses up to 4 times the human dose for Factor VIII stimulation on a mg/m² basis (or 12.5 times the human dose on a mg/kg basis) and doses up to 4 times the human dose for diabetes insipidus on a mg/m² basis (or 12.5 times the human dose on a mg/kg basis) were studied. There are several publications of management of diabetes insipidus in pregnant women with no harm to the fetus reported.
Data on a limited number (n=53) of exposed pregnancies in women with diabetes insipidus indicate rare cases of malformations in children treated during pregnancy. To date, no other relevant epidemiological data are available. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development.
Caution should be exercised when prescribing to pregnant women. Blood pressure monitoring is recommended due to the increased risk of pre-eclampsia.
There have been no controlled studies in nursing mothers. A single study on a post-partum woman demonstrated a marked change in plasma desmopressin acetate level following an intranasal dose of 10 mcg, but little drug was detectable in breast milk.
Results from analyses of milk from nursing mothers receiving high dose desmopressin (300 micrograms intranasally) indicate that the amounts of desmopressin that may be transferred to the child are considerably less than the amounts required to influence diuresis or haemostasis.
No studies on the effect of desmopressin on the ability to drive and use machines have been performed.
Desmopressin has no known effect on the ability to drive and use machines.
Side-effects include headache, stomach pain and nausea. Isolated cases of allergic skin reactions and more severe general allergic reactions have been reported. Very rare cases of emotional disorders including aggression in children have been reported. Treatment with desmopressin without concomitant reduction of fluid intake may lead to water retention/hyponatraemia with accompanying symptoms of headache, nausea, vomiting, weight gain, decreased serum sodium and in serious cases, convulsions.
The following undesirable effects of desmopressin were recorded from clinical studies and postmarketing experience. Adverse reactions are listed according to the following categories: Very common >1/10, Common >1/100 <1/10, Uncommon >1/1,000 <1/100, Rare >1/ 10,000 <1/1,000, Very rare <1/10,000, including isolated reports.
Uncommon: headache
Rare: cerebral oedema
Very rare: emotional disturbance in case of nocturnal enuresis
Common: conjunctivitis
Uncommon: nasal congestion, epistaxis, rhinitis
Uncommon: nausea, abdominal cramps, vomiting
Common: asthenia
Very rare: allergic and hypersensitivity reactions (e.g. pruritus, exanthema, fever, bronchospasms, anaphylaxis).
Rare: hyponatraemia
Due to increased water reabsorption blood pressure may rise and in some cases hypertension may develop. In patients with coronary heart disease angina pectoris may occur.
These adverse effects, except for allergic reactions, may be prevented or disappear if the desmopressin dose is reduced.
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