Desmopressindosage

For intranasal use only Instruct patients to prime pump prior to use Adults: 10 mcg to 40 mcg daily (either as a single dose or divided into two or three daily doses) Pediatrics: 10 mcg once daily into one nostril up to 30 mcg once daily (or 30 mcg divided as 20 mcg during the morning and 10 mcg at night) See the Full Prescribing Information for recommendations for switching between desmopressin acetate formulations

2.1 Important

Administration Instructions Administer desmopressin nasal spray by intranasal use only. Instruct patients about appropriate fluid restriction during desmopressin nasal spray treatment. Must prime the spray pump prior to the first use.

Instruct patients to: Prime pump by pressing down on pump four times (if the spray pump is not used for one week, re-prime the pump by pressing down on the pump once). Discard desmopressin nasal spray after 50 sprays since the amount delivered thereafter may be substantially less than the recommended dosage.

2.2 Recommended

Dosage The use of desmopressin nasal spray is not indicated for patients who require less than 10 mcg doses or doses that are not multiples of 10 mcg because the spray pump can only deliver doses of 10 mcg. If other doses are required, use another desmopressin acetate product. Individualize the dosage of desmopressin nasal spray for each patient with particular attention in pediatric and elderly patients and adjust according to the diurnal pattern of response to limit nocturia and to ensure fluid intake with respect to urine output is not excessive. Monitor continued response to desmopressin nasal spray by urine volume and osmolality to ensure adequate diuresis to limit the risk of hyponatremia, and include measurements of serum sodium and plasma osmolality as needed. Adults The recommended dosage in adults is 10 mcg once daily into one nostril up to 40 mcg once daily (or 40 mcg divided into two or three daily doses). If administered more than once a day, adjust for an adequate diurnal rhythm of urine output. Pediatric Patients For pediatric patients requiring doses less than 10 mcg, desmopressin nasal spray is not indicated. For pediatric patients 4 years of age and older, the recommended starting dosage of desmopressin nasal spray is 10 mcg once daily into one nostril. The dose can be titrated up to 30 mcg once daily (or 30 mcg divided into two daily doses, typically with 20 mcg given in the morning and 10 mcg given at nighttime). If administered more than once a day, adjust for an adequate diurnal rhythm of urine output. Because administration of desmopressin acetate can be associated with decreased responsiveness with prolonged use, consider increasing the dosage of desmopressin nasal spray if patients demonstrate decreased response over a long period of time.

2.3 Switching

Between Desmopressin Acetate Formulations When switching from the desmopressin acetate injection to desmopressin nasal spray, administer 10 times the amount of desmopressin acetate, rounding down to the nearest 10 mcg. When switching from the desmopressin acetate tablets to desmopressin nasal spray individual dose titration is required because intranasal desmopressin is approximately 10 to 40 fold more potent than oral (tablet) desmopressin.