Desmopressin (Paediatric)

PAEDIATRIC POPULATION: the SPC states desmopressin is indicated for treatment in this population and that 'Dose recommendations are the same as in adults' — the dose is a fixed sublingual dose, not a per-kg dose, which is why paedDose is null; the regimen above applies to children from 5 years of age. Paediatric dosing should also be verified against a children's formulary. FLUID RESTRICTION IS MANDATORY in enuresis: fluid intake must be limited to a minimum from 1 hour before administration until the next morning (at least 8 hours after). Treatment without concomitant reduction of fluid intake may lead to water retention and/or hyponatraemia, with or without warning signs (headache, nausea/vomiting, weight gain and, in severe cases, convulsions). If such signs occur, interrupt treatment until the patient has fully recovered, and enforce strict fluid restriction when restarting. DURATION: sublingual tablets are intended for treatment periods of up to 3 months; reassess the need for continued treatment by means of a period of at least 1 week without the medicine. If adequate clinical effect is not achieved within 4 weeks following appropriate dose titration, discontinue. DIABETES INSIPIDUS: dosage is individual; a suitable starting dose in adults AND children is 60 micrograms three times daily sublingually, adjusted according to response; for the majority of patients the maintenance dose is 60 micrograms to 120 micrograms sublingually three times daily. POST-HYPOPHYSECTOMY POLYURIA/POLYDIPSIA: the dose should be controlled by measurement of urine osmolality. ELDERLY: initiation of treatment in patients over 65 years of age is not recommended. HEPATIC IMPAIRMENT: no dose adjustment needed. Food intake may reduce the intensity and duration of the antidiuretic effect at low doses. Interrupt treatment during acute intercurrent illnesses characterised by fluid and/or electrolyte imbalance (systemic infections, fever, gastroenteritis). Consider severe bladder dysfunction and outlet obstruction before starting treatment for enuresis. NOTE: the US label in the same bundle (desmopressin acetate TABLETS, American Health Packaging) is a different formulation with different figures (central diabetes insipidus: start 0.05 mg twice daily, usual range 0.1 mg to 0.8 mg daily in divided doses, total daily range 0.1 mg to 1.2 mg; primary nocturnal enuresis from age 6 years: 0.2 mg at bedtime, titrated up to 0.6 mg) — these are oral-tablet US figures and have NOT been used for the dose above.