MINIRIN
DESMOPRESSIN · by ATCO
Composition
Inj 4 mcg/15 mcg: Per ml: Desmopressin acetate 4 mcg/15 mcg; 1 ml amp. Tab 0.1 mg/0.2 mg: Desmopressin 100 mcg/200 mcg. Spray 0.01 mg: Per dose: Desmopressin 10 mcg; 2.5 ml soln.
Indications & Dosage
Diabetes insipidus, treatment: ORAL: Adult: Initially 100 mcg 3 times a day; maintenance 100-200 mcg 3 times a day; usual dose 0.2-1.2 mg daily. Children 1-23 months: Initially 10 mcg 2-3 times a day, adjusted according to response; usual dose30-150 mcg daily; 2-11 years: Initially 50 mcg 2-3 times a day, adjusted according to response; usual dose100-800 mcg daily; 12-17 years: Initially 100 mcg 2-3 times a day, adjusted according to response; usual dose 0.2-1.2 mg daily. BY INTRANASAL SPRAY: Adult: 10-40 mcg daily in 1-2 divided doses. Children 1-23 months: Initially 2.5-5 mcg 1-2 times a day, adjusted according to response; 2-11 years: Initially 5-20 mcg 1-2 times a day, adjusted according to response; 12-17 years: Initially 10-20 mcg 1-2 times a day, adjusted according to response. BY SC INJ, OR BY IV INJ, OR BY IM INJ: Adult: 1-4 mcg daily. Primary nocturnal enuresis: Adult 18-65 years: 200 mcg once daily at bedtime, increased to 400 mcg only if lower dose not effective; withdraw 1 week before reassessment after 3 months, limit fluid intake from 1 hour before to 8 hours after administration. Children 5-17 years: 200 mcg once daily at bedtime, increased to 400 mcg only if lower dose not effective; withdraw 1 week before reassessment after 3 months, limit fluid intake from 1 hour before to 8 hours after administration. Postoperative polyuria or polydipsia: Adult: Adjusted dose according to urine osmolality. Diabetes insipidus, diagnosis (water deprivation test): BY INTRANASAL SPRAY: Adult: 20 mcg, limit fluid intake to 500ml from1 hour before to 8 hours after administration BY IM INJ, OR BY SC INJ: Adult: 2 mcg for 1 dose, limit fluid intake to500ml from 1 hour before to 8 hours after administration. Nocturia associated with multiple sclerosis (when other treatments have failed): BY INTRANASAL SPRAY: Adult 18-65 years: 10-20 mcg once daily, to be taken at bedtime, dose not to be repeated within 24 hours, limit fluid intake from 1 hour before to 8 hours after administration. Renal function testing: BY INTRANASAL SPRAY: Adult: 40 mcg, empty bladder at time of administration and limit fluid intake to 500ml from1 hour before until 8 hours after administration to avoid fluid overload. BY SC INJ, OR BY IM INJ: Adult: 2 mcg, empty bladder at time of administration and restrict fluid intake to 500ml from1 hour before until 8 hours after administration to avoid fluid overload. Mild to moderate haemophilia and von Willebrands disease: BY INTRANASAL SPRAY: Adult: 300 mcg every 12 hours if required, one150 mcg spray into each nostril, 30 minutes before surgery or when bleeding, dose may alternatively be repeated at intervals of at least 3 days, if self-administered. BY IV INF, OR BY SC INJ: Adult: 300 nanograms/kg for 1 dose, to be administered immediately before surgery or after trauma; may be repeated at intervals of 12 hours. Fibrinolytic response testing: BY INTRANASAL SPRAY: Adult: 300 mcg, blood to be sampled after1 hour for fibrinolytic activity, one 150 mcg spray to be administered into each nostril BY SC INJ, OR BY IV INJ: Adult: 300 nanograms/kg for 1 dose, blood to besampled after 20 minutes for fibrinolytic activity. Lumbar-puncture-associated headache: BY IM INJ, OR BY SC INJ: Adult: (consult product literature).
Administration
Dilute in 0.9% NaCI and infuse over 15-30 min; dose should be diluted in 10 ml NS for children < 10 kg; 50 ml NS for adults and children > 10 kg.
Stability
Store under refrigeration at 2C-8C (36F-46F).
Contraindications
Cardiac insufficiency, conditions treated with diuretics, history of hyponatraemia, polydipsia in alcohol dependence, psychogenic polydipsia, syndrome of inappropriate ADH secretion (in adults) Habitual, psychogenic polydipsia, cardiac insufficiency, other conditions requiring diuretic treat-ment.
Precautions
Asthma, avoid fluid overload, cardiovascular disease and hypertention (not indicated for nocturnal enuresis or nocturia), conditions which might be aggravated by water retention, cysticfibrosis, elderly (avoid for primary nocturnal enuresis and nocturia associated with multiple sclerosis), epilepsy, heart failure, migraine, should not be given intranasally fornocturnal enuresis due to an increased incidence of side-effects. Elderly patients are at increased risk of hyponatraemia andrenal impairment; monitor sodium concentration regularly during treatment; discontinue treatment if levels fall below the normal range. Review treatment if notherapeutic benefit after 3 months
Interactions
Indomethacin, tricyclic antidepressants, chlor-promazine, carbamazepine, other pressor agents.
Pregnancy
Caution advised
Lactation
Caution advised
Side Effects
Hyponatraemia with convulsions on administration without restricting fluid intake, nausea, allergic reactions, emotional disturbance in children, epistaxis, fluid retention, headache, nasal congestion, stomach pain, vomiting, Rhinitis (with intranasal use)