Desmopressin (DDAVP®) for diabetes insipidus How does this medicine work? Diabetes inspidus (DI) is a decrease in vasopressin, a hormone made by the pituitary gland, which controls the making of urine. Lack of this hormone causes increased urination and may lead to high body sodium levels. If DI is not treated, dehydration and seizures may occur. Giving DDAVP into the nose 1. Make sure you have the correct DDAVP solution. • If your prescription is for DDVAP given by a special nasal tube system, the concentration should be 100mcg in each 1 ml of medicine. • If your prescription is for DDVAP nose spray, the concentration of the medicine should be 10 mcg in each spray. • Do not use the more concentrated nose spray called Stimate®. It has a different purpose. DI may be caused by a brain tumor or injury, but many times the cause is unknown. Desmopressin (DDAVP) is a synthetic form of vasopressin. It works on the kidneys to help decrease the amount of urine made. How is the medicine given? DDAVP can be given by mouth, into the nose, or into a vein (IV). It may be given in the hospital, clinic, or home. Your doctor will explain how much DDAVP to give and how often to give it. Give the medicine at regular times to keep a steady level in the bloodstream. Giving DDAVP by mouth 2. Read the patient instruction guide for DDAVP before giving it. 3. If possible, children should blow their nose to clear out any mucus before receiving DDAVP. (If your child cannot do this, bulb-suction mucus out of the nose.) Using the tube system 1. If this is the first time you open a bottle, pull the security seal off of the bottle’s neck. For children who cannot swallow pills: 1. Crush the tablet between 2 spoons, inside a plastic bag, or in folded paper. 2. Mix the powder with a very small amount of soft food, such as applesauce, chocolate syrup, ice cream, jelly, or yogurt. Desmopressin for diabetes insipidus Page 1 of 3 2. Remove the plastic cap. 5. Tilt the child’s head back and gently insert the arrow-marked end of the tube into the nose. 3. Twist off the small seal from the dropper and set aside. Do not throw it away. 6. Place the other end of the tube in your mouth and give a short, strong puff of air into the tube to give the medicine into the nose. 7. Tell the child to sniff in (if able) as the medicine is put into the nose. 4. Measure the exact amount of medicine into the nasal tube: • Hold the arrow-marked part of the tube in one hand and the end of the dropper bottle in the other hand. • Insert the tip of the dropper into the end of the tube and hold the tube lower than the dropper tip. • Squeeze the dropper steadily until the medicine reaches the dose mark. Do not start and stop the squeezing, to prevent air bubbles. 8. Older children can be taught to blow their own medicine into their nose. Desmopressin for diabetes insipidus Page 2 of 3 9. Put the small seal back on the dropper tip to prevent leaking. Put the plastic cap on the bottle. Are there any precautions for my child’s diet? The doctor or nurse will give you specific instructions if fluids need to be restricted. There are no restrictions for solid foods. What should I do if a dose is missed? If the usual dose is once a day, give the missed dose as soon as possible. Then go back to your normal dosing schedule. If you do not remember until the next day, skip the missed dose and go back to your regular dosing schedule. Do not give two doses in the same day unless instructed. 10. Wash the tube with water and shake well, until no more water is left. If the markings become faint, darken them with a permanent marker. Using the nose spray 1. Before using the medicine the first time, prime it by spraying into the air 4 times. If it has not been used for a week or more, prime it again by spraying once. 2. Give the prescribed number of sprays. If the usual dose is more than once a day, give the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Never give a double dose. If you have any questions on how to make up a missed dose, please call the doctor. What are the side effects? Common • • fluid retention redness and warmth in face Occasional • • • • • • runny or stuffy nose headache nausea (upset stomach) dizziness increased heart rate pain, redness, or swelling at the IV site (if given IV) Rare • slight increase or decrease in blood pressure blood clots in undesired areas seizure 3. Tell the child to sniff in (if able) as the medicine is sprayed into the nose. 4. Rinse the spray tip with hot water and dry with a clean cloth or tissue. Other instructions: ____________________________________ ____________________________________ ____________________________________ • • Desmopressin for diabetes insipidus Page 3 of 3 When should I call the doctor? • headaches or other pain not relieved by acetaminophen (such as Tylenol ) irritation or bleeding in the nose (if using the nose solution) faster heart rate rapid weight gain dizziness vision problems confusion seizures signs of an allergic reaction: - fever or chills - rash or hives - wheezing - trouble breathing- call 911 ® • • • • • • • • What else do I need to know? DDAVP should not be used by any patient who has heart problems or who has ever had a blood clot. If you are using the spray, check the bottle for the number of sprays it contains. After that number of sprays, throw the bottle away (even if there is still some liquid in the bottle). The patient instruction sheet that comes with it tells you how to keep track of the number of sprays. Always make sure you have enough medicine on hand. Each time you refill your prescription, check to see how many refills are left. If no refills are left, the pharmacist will need 2 or 3 days to contact the doctor to renew the prescription. Before giving the first dose, read the label. Be sure it is what was prescribed. After a refill, if the medicine looks different to you, ask your pharmacist about it before giving it. Check the label for the expiration date. Flush outdated medicines down the toilet instead of putting them in the garbage. It is best to store this medicine in the refrigerator, as far from children’s reach as possible. Do not let it freeze. Closed bottles are good for up to 3 weeks at room temperature (68º to 77º F or 20º to 25º C). If too much or the wrong kind of medicine is taken, call the doctor right away. Questions? This sheet is not specific to your child but provides general information. If you have any questions, please call the doctor or pharmacist. For more reading material about this and other health topics, please call or visit the Family Resource Center library, or visit our Web site: www.childrensmn.org. Children’s Hospitals and Clinics of Minnesota Patient/Family Education 2525 Chicago Avenue South Minneapolis, MN 55404 1/10 Copyright Desmopressin for diabetes insipidus Page 4 of 3