From the Guidelines
Diabetes insipidus is primarily treated with desmopressin (DDAVP) for central diabetes insipidus and thiazide diuretics like hydrochlorothiazide for nephrogenic diabetes insipidus, with treatment individualized based on the specific type of diabetes insipidus and patient characteristics. The treatment approach for diabetes insipidus varies depending on the type of the condition. For central diabetes insipidus, desmopressin is typically started at 10 mcg intranasally once or twice daily, 0.1-0.2 mg orally twice daily, or 1-2 mcg subcutaneously or intravenously as needed, with the dose adjusted based on symptom control and serum sodium levels 1. In contrast, for nephrogenic diabetes insipidus, thiazide diuretics like hydrochlorothiazide (25-50 mg daily) are often used, sometimes combined with amiloride (5-10 mg daily) or indomethacin (25-50 mg three times daily) 1. Patients should monitor fluid intake and output, maintain adequate hydration, and have regular electrolyte checks. Desmopressin works by replacing the missing antidiuretic hormone (vasopressin) in central diabetes insipidus, while thiazides paradoxically reduce urine output in nephrogenic diabetes insipidus by promoting sodium and water reabsorption in the proximal tubule, reducing water delivery to the collecting duct where the defect exists 1. Additionally, recommendations for treatment and follow-up in children with nephrogenic diabetes insipidus include free access to fluid, normal-for-age milk intake, and considering tube feeding in infants and children with repeated episodes of vomiting and dehydration and/or failure to thrive 1. It is essential to individualize treatment based on the specific type of diabetes insipidus and patient characteristics, and to monitor treatment efficacy via urine osmolality, urine output, weight gain, and growth. Ongoing drug treatment should be based on the balance of apparent efficacy and concern over development of side effects, and patients with nephrogenic diabetes insipidus should be followed by a multidisciplinary team that includes a (paediatric) nephrologist, dietitian, psychologist, social worker, and urologist.
From the FDA Drug Label
Desmopressin Acetate Injection is indicated as antidiuretic replacement therapy in the management of central (cranial) diabetes insipidus and for the management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region Desmopressin Acetate Injection is ineffective and not indicated for the treatment of nephrogenic diabetes insipidus.
Medications for Diabetes Insipidus:
- Desmopressin acetate is used to treat central diabetes insipidus.
- It is not effective for nephrogenic diabetes insipidus. Key points to consider when using desmopressin acetate for diabetes insipidus:
- Monitor serum sodium levels before and during treatment.
- Restrict free water intake to prevent hyponatremia.
- Use with caution in patients at increased risk of severe hyponatremia 2.
From the Research
Diabetes Insipidus Medications
- Desmopressin is recognized as the drug of choice for central diabetes insipidus due to its selective antidiuretic activity 3.
- It has a greatly enhanced therapeutic profile compared to previously available treatments, allowing more specific antidiuresis without adverse reactions 3.
- Desmopressin is available for intranasal and parenteral administration, with antidiuretic doses ranging from 10 to 40 micrograms intranasally and from 2 to 4 micrograms intravenously or subcutaneously 3.
Administration and Dosage
- The management of central diabetes insipidus has been greatly simplified by the introduction of desmopressin, with its ease of administration, safety, and tolerability making it the first-line agent for outpatient treatment 4.
- Desmopressin orally disintegrating tablet (ODT) has been shown to be effective and safe in patients with central diabetes insipidus, with similar antidiuresis to intranasal desmopressin 5.
- The mean daily dose ratio of intranasal desmopressin to desmopressin ODT was 1:24, but a wide range was observed across individuals to maintain adequate antidiuretic effect 5.
Side Effects and Considerations
- The major complication of desmopressin therapy is water intoxication and hyponatremia, which can be reduced by careful dose titration and close monitoring of serum osmolality 4.
- Hyponatraemia was generally mild and managed by dose titration in patients treated with desmopressin ODT 5.
- Oral desmopressin is used in the majority of patients, including infants and toddlers, with wide inter-individual variation in dose requirement and dosing intervals 6.