Desmopressin (Nasal route)
- DDAVP Rhinal Tube
Noctiva(TM) can cause hyponatremia. Severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest or death. Noctiva(TM) is contraindicated in patients at increased risk of severe hyponatremia, such as patients with excessive fluid intake, illnesses that can cause fluid or electrolyte imbalances (eg, gastroenteritis, salt-wasting nephropathies, or systemic infection), and in those using loop diuretics or systemic or inhaled glucocorticoids. Ensure serum sodium concentrations are normal before starting or resuming Noctiva(TM). Measure serum sodium within 7 days and approximately 1 month after initiating therapy or increasing the dose, and periodically during treatment. More frequently monitor serum sodium in patients 65 years of age and older and in patients at increased risk of hyponatremia. If hyponatremia occurs, Noctiva(TM) may need to be temporarily or permanently discontinued .
Uses of This Medicine:
Desmopressin nasal spray is used to treat central cranial diabetes insipidus. This is a condition that causes the body to lose too much fluid and become dehydrated. It is also used to control frequent urination and increased thirst caused by certain types of brain injury or brain surgery. The Stimate® nasal spray is used to treat bleeding in patients with hemophilia A or von Willebrand disease (Type I).
Noctiva™ nasal spray is used to treat nocturnal polyuria in adults who awaken two or more times to urinate at night. Nocturnal polyuria is a condition where your body makes too much urine at night. Your doctor will need to measure your urine and the times that you urinate for 24 hours to determine if you have nocturnal polyuria.
Desmopressin is similar to a hormone that is produced in the body. It acts on the kidneys to reduce the flow of urine. For bleeding, desmopressin increases the blood levels of factor VIII and von Willebrand factor. This results in less bleeding for patients who have low levels of these agents.
This medicine is available only with your doctor's prescription.
Before Using This Medicine:
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of desmopressin nasal spray to treat central diabetes insipidus in children 3 months of age and older for desmopressin acetate or in children 4 years of age and older for DDAVP®. Safety and efficacy have been established.
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of Stimate® to treat hemophilia A and von Willebrand disease in children 11 months of age and older. However, use is not recommended in children younger than 11 months of age.
Appropriate studies have not been performed on the relationship of age to the effects of Noctiva™ in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of desmopressin nasal spray in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving desmopressin.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of Noctiva™ in the elderly. However, elderly patients are more likely to have hyponatremia (low sodium in the blood), which may require caution and an adjustment in the dose for patients receiving Noctiva™.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Ethacrynic Acid
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amtolmetin Guacil
- Choline Salicylate
- Flufenamic Acid
- Mefenamic Acid
- Morphine Sulfate Liposome
- Niflumic Acid
- Nimesulide Beta Cyclodextrin
- Opium Alkaloids
- Salicylic Acid
- Sodium Salicylate
- Tiaprofenic Acid
- Tolfenamic Acid
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other medical problems—
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Blood clotting problems or
- Hypertension (high blood pressure) or
- Hypotension (low blood pressure) or
- Tachycardia (increased heart rate)—Use with caution. May make these conditions worse.
- Coronary artery disease or
- Cystic fibrosis or
- Heart failure or
- Kidney problems or
- Polydipsia (excessive thirst), habitual or psychogenic—Use with caution. May cause side effects to become worse.
- Congestive heart failure or
- Head injury or
- Hypertension (high blood pressure), uncontrolled or
- Urinary retention, or history of—Noctiva™ can cause fluid retention, and should not be used in patients with these conditions.
- Gastroenteritis or
- Infection (systemic) or
- Polydipsia (excessive thirst) or
- Primary nocturnal enuresis (bed-wetting at night) or
- Salt-wasting nephropathies or
- Syndrome of inappropriate antidiuretic hormone (SIADH), known or suspected—Noctiva™ should not be used in patients with these conditions.
- Hyponatremia (low sodium in the blood), or history of or
- Kidney disease, moderate to severe—Should not be used in patients with these conditions.
- Nose problems (eg, blockage, nasal mucosa atrophy, rhinitis) or
- Nose surgery (eg, transsphenoidal hypophysectomy)—Use with caution. May increase risk for more serious side effects.
- Type IIB von Willebrand disease—Stimate® should not be used in patients with this condition.
Proper Use of This Medicine:
Use this medicine exactly as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.
This medicine comes with Medication Guide or patient information leaflet and patient instructions. Read and follow these instructions carefully. Ask your doctor if you have any questions.
This medicine should only be used in the nose.
Your doctor may limit the amount of fluid or water you drink. Follow the instructions carefully to prevent unwanted effects.
To use the nasal spray:
- When used for the first time, the spray must be primed. Press the pump down 4 times. If the spray is not used for 1 week, prime the pump again by pressing once.
- Gently blow your nose before using the spray. Tilt your head back slightly and insert the tip of the nose piece into your nostril.
- Close the opposite nostril with a finger. Release one spray and breathe in gently at the same time.
- Hold your breath for a few seconds then breathe out slowly through the mouth.
- If a second dose is needed, spray the opposite nostril using the same steps.
- Do not blow your nose or tip your head back after using the spray.
- Wipe the tip of the bottle with a clean, dry tissue and replace the cap.
- Throw away any unused medicine after 25 sprays (Stimate®) or 50 sprays (DDAVP® or desmopressin generic).
To use the DDAVP® Rhinal Tube nasal system:
- The rhinal tube applicator is a soft, flexible plastic tube with numbers printed on the side. The numbers represent the dose.
- Place the correct amount of medicine in the tube by inserting the tip of the container in the end of the tube that is marked with an arrow.
- Put the end of the tube that is marked with an arrow into one nostril and put the other end into your mouth.
- Hold your breath, tilt the head back, and blow with a short, strong puff until all the medicine is sprayed into the nose.
- Do not let medicine run into your throat.
- For young children, an adult must blow the medicine into the nose.
- Wash the tube with water and shake it to remove all of the water.
- Put the seal back on the container tip and replace the plastic cap.
To use the Noctiva™ nasal spray:
- When used for the first time, the spray must be primed. Press the pump down 5 times. If the spray is not used for more than 3 days, prime the pump again by pressing 2 times.
- Do not shake the bottle.
- Gently blow your nose before using the spray. Tilt your head back slightly and insert the nasal applicator into your left or right nostril.
- Close the opposite nostril with a finger. Release one spray and breathe in gently at the same time.
- Wipe the nasal applicator with a clean, dry tissue and replace the cap.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For nasal dosage form (nasal spray):
- For treatment of central diabetes insipidus:
- Adults—10 micrograms (mcg) given into one nostril. Your doctor may increase your dose up to 40 mcg divided into 2 or 3 doses per day.
- Children 4 years of age and older—At first, 10 mcg once a day into one nostril. Your doctor may increase the dose up to 30 mcg given once a day or divided into 2 doses (20 mcg in the morning and 10 mcg at nighttime).
- Children younger than 4 years of age—Use is not recommended.
- Desmopressin acetate:
- Adults and children 13 years of age and older—0.1 to 0.4 milliliter (mL) given as a single dose or divided into 2 or 3 doses per day. The dose is given in one nostril or divided and given in both nostrils. Your doctor may adjust the dose as needed.
- Children 3 months to 12 years of age—0.05 to 0.3 mL given as a single dose or divided into 2 doses per day. The dose is given in one nostril or divided and given in both nostrils. Your doctor may adjust the dose as needed.
- Children younger than 3 months of age—Use and dose must be determined by your doctor.
- For treatment of hemophilia A or won Willebrand disease:
- Adults and children 13 years of age and older—One spray (0.1 milliliter) in each nostril as a single dose per day. Your doctor may adjust the dose as needed.
- Children 11 months to 12 years of age—Use and dose must be determined by your doctor.
- Children younger than 11 months of age—Use is not recommended.
- For treatment of nocturnal polyuria:
- Adults younger than 65 years of age who are not at increased risk for hyponatremia—One spray (1.66 micrograms [mcg]) in either left or right nostril 30 minutes before going to bed.
- Older adults 65 years of age or older—At first, one spray (0.83 mcg) in either left or right nostril 30 minutes before going to bed. After 7 days, your doctor will increase your dose to 1.66 mcg as needed.
- Children—Use and dose must be determined by your doctor.
- For treatment of central diabetes insipidus:
If you miss a dose of this medicine, take it 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. Do not double doses.
If you miss a dose of Noctiva™, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
DDAVP® or desmopressin generic: Store at room temperature in an upright position.
DDAVP® Rhinal Tube System: Store in the refrigerator in an upright position. For travelers, the product is good for up to 3 weeks at room temperature.
Stimate®: Store at room temperature in an upright position. Throw the bottle away 6 months after it is used for the first time.
Noctiva™: Keep the unopened nasal spray bottle in the refrigerator in an upright position. You may store the opened bottle at room temperature. Throw away 60 days after opening.
Precautions While Using This Medicine:
It is very important that your doctor check your or your child's progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to use it. Blood and urine tests may be needed to check for unwanted effects.
Do not use Noctiva™ together with certain diuretics (eg, furosemide, torsemide, Demadex®, Lasix®) and systemic or inhaled glucocorticoids (eg, dexamethasone, fluticasone, methylprednisolone, prednisolone, prednisone, Cortef®, Medrol®).
This medicine lowers the amount of sodium in your blood. Check with your doctor right away if you have confusion, nausea, vomiting, muscle cramps or spasms, or unusual tiredness or weakness.
Desmopressin may rarely cause severe allergic reactions, including anaphylaxis, which can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a rash, itching, swelling of the face, tongue, and throat, trouble breathing, or chest pain after you use this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Side Effects of This Medicine:
- difficulty swallowing
- puffiness or swelling of the eyelids or around the eyes
- skin rash, hives, or itching
- tightness in the chest
- trouble breathing
- unusual tiredness or weakness
- Incidence not known
- Blurred vision
- body aches or pain
- chest pain
- decreased urine output
- ear congestion
- fast, irregular, pounding, or racing heartbeat or pulse
- increased thirst
- loss of consciousness
- loss of voice
- muscle pain or cramps
- pounding in the ears
- runny or stuffy nose
- slow or fast heartbeat
- sore throat
- swelling of the face, ankles, or hands
- Less common
- Bloody nose
- burning, dry, or itching eyes
- eye discharge or excessive tearing
- loss of appetite
- passing gas
- redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
- stomach pain, fullness, or discomfort
- Incidence not known
- feeling of warmth
- redness of the face, neck, arms, and upper chest
- sleepiness or unusual drowsiness
- stomach cramps
- trouble sleeping
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Last Updated: 3/30/2022