Desmopressin Nasal Spray Dosage and Usage
Oral formulations of desmopressin are preferred over nasal spray for most indications, as the nasal spray has been associated with higher risk of water intoxication, hyponatremia, and convulsions, leading to removal of the enuresis indication for nasal spray in many countries. 1
Indications and Available Formulations
- Desmopressin nasal spray is primarily indicated for central cranial diabetes insipidus 2
- The nasal spray formulation is available as a 0.01% solution 2
- While historically used for nocturnal enuresis, this indication has been removed for the nasal spray in many countries due to safety concerns 1
- Desmopressin can also be used for nosebleeds in patients taking platelet-inhibiting drugs or with von Willebrand disease 3
Dosage for Central Cranial Diabetes Insipidus
- For adults: 0.1 mL to 0.4 mL daily (10-40 mcg), either as a single dose or divided into two or three doses 2
- Most adults require 0.2 mL daily (20 mcg) in two divided doses 2
- For children aged 3 months to 12 years: 0.05 mL to 0.3 mL daily (5-30 mcg), either as a single dose or divided into two doses 2
- Approximately 1/4 to 1/3 of patients can be controlled by a single daily dose 2
Administration Instructions
- The nasal spray pump delivers doses of 0.1 mL (10 mcg) or multiples of 0.1 mL 2
- The spray pump must be primed prior to first use by pressing down five times 2
- Discard the nasal spray solution after 50 sprays as subsequent sprays may deliver substantially less than 10 mcg of drug 2
- For doses other than multiples of 0.1 mL, the rhinal tube delivery system may be used 2
Special Populations
- Geriatric patients: Dose adjustment may be necessary as the drug is substantially excreted by the kidney 2
- Monitoring renal function is recommended in elderly patients 2
- Infants and toddlers: Oral formulations are generally preferred, but nasal spray can be used with careful monitoring 4
Safety Considerations and Precautions
- Fluid restriction should be observed to prevent water intoxication 2
- Risk of hyponatremia is higher with nasal spray compared to oral formulations 1
- Evening fluid intake should be limited to 200 mL (6 ounces) or less, with no drinking until morning 1
- Polydipsia is a contraindication to desmopressin treatment 1
- Management remains challenging in adipsic patients and young children during intercurrent illness 4
Alternative Formulations
- Oral tablets (0.2-0.4 mg) or oral melt tablets (120-240 mcg) are preferred alternatives 1
- Oral tablets should be taken at least 1 hour before sleep 1
- Oral melt tablets should be taken 30-60 minutes before bedtime 1
- For hemostatic effects in bleeding disorders, intravenous dosing at 0.3 μg/kg is typically used 3, 5
Monitoring and Follow-up
- Response should be estimated by adequate duration of sleep and adequate water turnover 2
- Morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover 2
- Regular short drug holidays are important when using desmopressin daily to assess whether medication is still needed 1