[Use of desmopressin prior to surgery for patients with mild to moderate haemophilia and von Willebrand’s disease is outside the scope of this monograph]
Issues for Surgery |
For diabetes insipidus – severe harm or death (due to dehydration and hypernatraemia) have been reported in patients with cranial diabetes insipidus if doses are delayed or omitted (see Further Information)1. For primary nocturnal enuresis, idiopathic nocturnal polyuria, nocturia associated with multiple sclerosis – loss of symptomatic relief if omitted. For primary nocturnal enuresis – change in sodium levels if continued during episodes of diarrhoea and vomiting. |
Advice in the Perioperative period |
Establish indication for desmopressin. For patients with diabetes insipidus, desmopressin is a critical medication and must be continued. Check serum sodium pre-operatively, especially in elderly patients due to increased risk of hyponatraemia2. Check serum sodium post-operatively, especially in elderly patients due to increased risk of hyponatraemia, particularly when intravenous (IV) fluids are being administered2. Patients with Diabetes Insipidus Patients with Primary Nocturnal Enuresis If vomiting or diarrhoea occur post-operatively temporarily discontinue desmopressin until fluid balance returns to normal2. |
Interaction(s) with Common Anaesthetic Agents |
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Interaction(s) with other Common Medicines used in the Perioperative Period |
Hyponatraemia Concomitant administration of desmopressin with the following may increase the risk of fluid overload and / or hyponatraemia: -
This increased risk is likely to be small, and severe complications rare, however it would be prudent to exercise caution and monitor serum sodium a minimum of once daily6. If serum sodium level is below the usual reference range, consider an increase in the frequency of monitoring e.g., 12-hourly. Loperamide Loperamide is predicted to markedly increase the absorption of oral and sublingual desmopressin2, 6. For patients with primary nocturnal enuresis withhold desmopressin until diarrhoea resolves2, 6, but for all other indications monitor closely with concomitant use as the dose and / or frequency of oral and sublingual desmopressin may need to be reduced6. No interaction is expected with intranasal and parenteral desmopressin6. |
Further Information |
Desmopressin is available in many formulations, including a nasal spray, and is considered a life sustaining medication; however, there is a common misconception that it is not a critical medication as nasal sprays are commonly used to treat minor conditions. Symptoms of omitted desmopressin can include confusion, agitation, hostile and uncooperative behaviour therefore patients who would usually be aware of how vital their medication is are not always able to emphasise this to staff. Delayed or omitted doses of desmopressin have been associated with at least 4 deaths and 76 episodes of harm. |
References |
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