Does desmopressin (Deamino D-Arginine Vasopressin) cause hyponatremia?

From the Guidelines

Desmopressin can cause hyponatremia, particularly when combined with excessive fluid intake, as it increases water reabsorption in the kidneys, leading to water retention and potential dilution of sodium in the bloodstream. This is a critical consideration when prescribing desmopressin, especially for conditions like nocturnal enuresis, where the medication is often used to reduce nocturnal urine production 1. The risk of hyponatremia is higher when desmopressin is used in conjunction with high fluid intake, and it is essential to advise patients to limit their fluid intake, especially in the evening, to minimize this risk 1.

Key Considerations

• Desmopressin increases water reabsorption in the kidneys, which can lead to water retention and dilution of sodium in the bloodstream 1.
• The risk of hyponatremia is higher with excessive fluid intake, and patients should be advised to limit their fluid intake, especially in the evening 1.
• Oral formulations of desmopressin are preferred over nasal sprays due to a lower risk of hyponatremia 1.
• Patients with a history of polydipsia should not be treated with desmopressin due to the increased risk of hyponatremia 1.

Recommendations for Safe Use

• Start with lower doses of desmopressin and titrate carefully to minimize the risk of hyponatremia 1.
• Monitor patients for sodium levels, particularly when starting therapy or adjusting doses 1.
• Advise patients to limit fluid intake, especially in the evening, and to be alert for early symptoms of hyponatremia, such as headache, nausea, and confusion 1.

From the FDA Drug Label

Desmopressin acetate can cause hyponatremia. Severe hyponatremia can be life-threatening if it is not promptly diagnosed and treated, leading to seizures, coma, respiratory arrest, or death [see Boxed Warning]. Desmopressin acetate is contraindicated in patients with hyponatremia (or a history of hyponatremia), with excessive fluid intake (e.g., polydipsia), using loop diuretics or systemic or inhaled glucocorticoids, with known or suspected SIADH, and/or illnesses that can cause fluid or electrolyte imbalances [see Contraindications (4), Drug Interactions (7)]. WARNING: HYPONATREMIA Desmopressin acetate can cause hyponatremia. Severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest, or death [see Warnings and Precautions (5. 1)].

Yes, desmopressin can cause hyponatremia.

• Key points:
  • Desmopressin acetate is contraindicated in patients with hyponatremia or a history of hyponatremia.
  • Severe hyponatremia can be life-threatening.
  • Serum sodium concentration should be monitored within 1 week and approximately 1 month of initiating desmopressin acetate, and periodically thereafter.
  • Patients at increased risk of hyponatremia should be monitored more frequently 2, 2.

From the Research

Desmopressin and Hyponatremia

• Desmopressin can cause hyponatremia due to renal water retention, especially if fluid intake is not restricted 3.
• The risk of hyponatremia is higher in certain patient populations, such as the elderly, and those with underlying kidney disease or taking concomitant medications associated with hyponatremia 4.
• A population-based cohort study found that the rate of hyponatremia was 13-fold higher in adults prescribed desmopressin compared to those prescribed oxybutynin 5.

Management of Desmopressin-Induced Hyponatremia

• Desmopressin should not be withheld in patients with hyponatremia and neurologic symptoms, but instead continued while administering intravenous hypertonic saline solution 3.
• Desmopressin can be used to minimize water excretion during the correction of hyponatremia, and to prevent overly rapid "autocorrection" of serum sodium levels 3.
• A case report described the successful use of desmopressin and hypertonic saline to treat symptomatic desmopressin-induced hyponatremia 6.

Prevention of Desmopressin-Induced Hyponatremia

• Using the minimum effective dose of desmopressin and monitoring serum sodium levels can help prevent hyponatremia 4.
• A proposed monitoring plan involves checking baseline sodium levels, and monitoring at week 1 and month 1 for patients at elevated risk of hyponatremia 4.
• A systematic review found that proactive administration of desmopressin with hypertonic saline may be associated with a lower incidence of exceeding serum sodium correction targets, but more research is needed to determine the optimal strategy for desmopressin administration 7.