Desmopressin acetate (patient information)

# Why is this medication prescribed?
- Nasal desmopressin is used to control the symptoms of a certain type of diabetes insipidus ('water diabetes'; condition in which the body produces an abnormally large amount of urine). Nasal desmopressin is also used to control excessive thirst and the passage of an abnormally large amount of urine that may occur after a head injury or after certain types of surgery. One brand of desmopressin nasal spray (Stimate) is used to stop bleeding in people who have certain bleeding disorders. Desmopressin is in a class of medications called hormones. It works by replacing vasopressin, a hormone that is normally produced in the body to help balance the amount of water and salt.

# How should this medicine be used?
- Nasal desmopressin comes as a liquid that is administered into the nose through a rhinal tube (thin plastic tube that is placed in the nose to administer medication), and as a nasal spray. It is usually used one to three times a day. If you are using desmopressin nasal spray (Stimate) to treat bleeding problems, your doctor will tell you when you should use the medication. Try to use nasal desmopressin at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use nasal desmopressin exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
- If you are using desmopressin nasal spray (Stimate) to treat bleeding problems, you will receive your first dose in a doctor's office. Your doctor will order laboratory tests to see if this dose was effective before you begin to use the medication on your own.- Your doctor may start you on a low dose of nasal desmopressin and gradually increase your dose. Follow these directions carefully.
- After you use nasal desmopressin for 6 months or longer, you may find that the medication does not work as well as it worked at the beginning of your treatment. Call your doctor if this happens.
- If you will be using the nasal spray, you should check the manufacturer's information to find out how many sprays your bottle contains. Keep track of the number of sprays you use, not including the priming sprays. Throw away the bottle after you use the stated number of sprays, even if it still contains some medication, because additional sprays might not contain a full dose of medication. Do not try to transfer the leftover medication to another bottle.
- To use the nasal spray, follow these steps:
- Remove the protective cap from the bottle.
- Press down on the pump 4 times to prime it before you use the spray bottle for the first time. If you have not used the spray bottle in longer than one week, press down on the pump once to re-prime it.
- Place the tip of the spray bottle in your nostril. Hold the bottle at an angle so that the dip tube inside the bottle draws from the deepest portion of the medication.
- Press the spray pump once.
- If your doctor told you to use 2 sprays, repeat steps 3-4, but place the tip of the spray bottle in your other nostril.
- Replace the protective cap on the bottle.
- To use the rhinal tube, follow these steps:
- Pull the plastic tag on the neck of the bottle. Break the security seal and remove the plastic cap.
- Twist the small seal off the tip of the dropper. Do not throw away or lose this seal because you will need it to close the bottle between uses.
- Hold the plastic tube in one hand and the top of the dropper in the other. Place the tip of the dropper into the end of the plastic tube that is marked with an arrow.
- Squeeze the dropper until the tube is filled up to the mark that matches the dose your doctor prescribed. Remove the tube from the bottle by pulling the bottle quickly downwards while keeping constant pressure on the dropper so that air bubbles will not form in the tube. Talk to your doctor if you have trouble filling the tube to the proper mark.
- Hold the tube so that your fingertips are about 3/4 inch (about 2 centimeters) from the end of the tube. Place the end of the tube in one nostril and push it in until your fingertips reach the nostril.
- Place the other end of the tube in your mouth.
- Hold your breath. Tilt your head back and blow into the tube with a short strong puff.
- Remove the tube from your nose and mouth.
- Replace the seal on the dropper and replace the plastic cap on the bottle.
- Wash the tube with water and shake thoroughly to dry.
- Ask your doctor for directions if you will be giving the medication to a baby or young child.

# Other uses for this medicine
- This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow?
- Before using nasal desmopressin,
- Tell your doctor and pharmacist if you are allergic to desmopressin or any other medications.
- Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); carbamazepine (Tegretol); chlorpromazine (Thorazine, Sonazine); chlorpropamide (Diabinese); clofibrate; demeclocycline (Declomycin); fludrocortisone; heparin; lamotrigine (Lamictal); lithium (Eskalith, Lithobid); narcotic (opiate) medications for pain; oxybutynin (Ditropan); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft); and urea (Pytest). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Other medications may also interact with desmopressin, so be sure to
- Tell your doctor about all the medications you are taking, even those that do not appear on this list.
- Tell your doctor if you have or have ever had kidney disease or a low level of sodium in your blood. Your doctor will probably tell you not to use desmopressin.
- Tell your doctor if you have or have ever had high blood pressure, any condition that causes you to be extremely thirsty, cystic fibrosis, blood clots, or heart disease. Also tell your doctor if you have recently had surgery of the head or face, and if you have a stuffed or runny nose, scarring or swelling of the inside of the nose, or atrophic rhinitis (condition in which the lining of the nose shrinks and the inside of the nose becomes filled with dry crusts).
- Call your doctor if you develop a stuffed or runny nose at any time during your treatment.
- Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using desmopressin, call your doctor.
- Ask your doctor about the safe use of alcoholic beverages while you are using desmopressin.

# What special dietary instructions should I follow?
- Your doctor may tell you to limit the amount of fluid you drink during your treatment with desmopressin. Follow your doctor's directions carefully to prevent serious side effects.

# What should I do if I forget a dose?
- Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.

# What side effects can this medication cause?
- Nasal desmopressin may cause side effects. Call your doctor if any of the following symptoms are severe or do not go away:
- Stomach pain
- Heartburn
- Weakness
- Dizziness
- Difficulty falling asleep or staying asleep
- Chills
- Warm feeling
- Nosebleed
- Nostril pain
- Red, swollen, or teary eyes
- Pain in the genital area
- Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately:
- Nausea
- Vomiting
- Loss of appetite
- Weight gain
- Headache
- Irritability
- Restlessness
- Extreme tiredness
- Confusion
- Slowed reflexes
- Muscle weakness, spasms, or cramps
- Hallucination (seeing things or hearing voices that do not exist)
- Seizures
- Loss of consciousness for a period of time
- Chest pain
- Fast or pounding heartbeat
- Rash
- Hives
- Itching
- Difficulty breathing or swallowing
- Nasal desmopressin may cause other side effects. Tell your doctor if you experience any unusual problems while using this medication.
- If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What should I know about storage and disposal of this medication?
- Keep this medication in the container it came in, tightly closed, and out of reach of children. Check the manufacturer's information to find out if the product you are using should be stored at room temperature or in the refrigerator. Store bottles of nasal spray in an upright position. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
- In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
- Symptoms of overdose may include:
- Confusion
- Drowsiness
- Headache
- Difficulty urinating
- Sudden weight gain

# What other information should I know?
- Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to desmopressin.
- Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
- It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

# Brand names
Concentraid
DDAVP Nasal
Minirin Nasal
Stimate Nasal