Overdose increases the risk of water retention and hyponatremia. Management of hyponatremia varies from person to person. In patients with non-symptomatic hyponatremia, desmopressin should be discontinued and fluid intake restricted. In patients with symptomatic hyponatremia, it is advisable to add isotonic or hypertonic sodium chloride to the drip. In cases of severe water retention (cramps and loss of consciousness), treatment with furosemide should be added.
Patients with habitual or psychogenic thirst; unstable angina pectoris; metabolic dysregulation cardiac insufficiency; type IIB vascular hemophilia. Special attention should be paid to the risk of water retention. Fluid intake should be reduced to as small a quantity as possible and weight should be checked regularly. If there is a gradual increase in body weight and blood sodium decreases below 130 mmol/L or plasma osmolality falls below 270 mosm/kg, fluid intake should be drastically reduced and desmopressin discontinued. Use with caution in patients who are too young or elderly; in patients with other disorders requiring diuretic therapy for fluid and/or solubility imbalances; and in patients at risk for increased intracranial pressure. Coagulation factors and bleeding time should be measured prior to use of this drug; plasma concentrations of VIII:C and VWF:AG increase substantially after administration, but it has not been possible to establish a correlation between plasma levels of these factors and bleeding time before and after administration. Therefore if possible, the effect of desmopressin on bleeding time in individual sufferers should be determined experimentally.
Bleeding time determinations should be standardized as far as possible, e.g., by the Simplate II method. Effects on Pregnancy and Lactation Reproductive tests in rats and rabbits administered at more than one hundred times the human dose have shown that desmopressin does not harm the embryo. One researcher has reported three cases of malformations in infants born to uremic pregnant women who used desmopressin during pregnancy, but other reports of more than 120 cases have shown that infants born to women who used desmopressin during pregnancy were normal.
In addition, a well-documented study demonstrated no increase in the rate of birth malformations in 29 infants born to pregnant women who used desmopressin during the entire pregnancy. Analysis of breast milk from nursing women treated with high doses (300ug intranasal) showed that the amount of desmopressin passed on to the infant was substantially less than the amount needed to affect diuresis and hemostasis.
Preparations: Anti-inflammatory drugs may enhance the patient’s response to desmopressin without prolonging its duration of action. Some substances known to release antidiuretic hormones, such as tricyclic antidepressants, chlorpromazine, and carbamazepine, potentiate the antidiuretic effect. Increases the risk of water retention.
Post time: Jan-23-2024