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Incontinence - urinary, in women - Management
What are the cautions and contraindications for desmopressin?
- Desmopressin should not be used in women with heart failure, psychogenic polydipsia, or polydipsia associated with alcohol dependence.
- Desmopressin should be used cautiously in people at higher risk of hyponatraemia, including those with [Micromedex, 2009]:
- The syndrome of inappropriate antidiuretic hormone secretion.
- Dipsogenic diabetes insipidus.
- Hepatic cirrhosis.
- Adrenal insufficiency.
- Hyperglycaemia.
- AIDS.
- Other drugs known to cause hyponatraemia.
- Desmopressin can also be used cautiously in women taking diuretics for conditions other than heart failure.
Clarification / Additional information
- Older people, particularly those who are hospitalized or living in long-term care facilities, are more at risk of drug-induced hyponatraemia [Kugler and Hustead, 2000; Palmer et al, 2003].
- Symptoms of hyponatraemia include [Baylis, 2003; Palmer et al, 2003]:
- Mild: anorexia, headache, nausea, vomiting, lethargy, oedema.
- Moderate: personality change, muscle cramps, muscle weakness, confusion, ataxia.
- Severe: drowsiness, convulsions, coma, death.
- Several drugs have been reported to cause hyponatraemia; those that are more commonly implicated include [Palmer et al, 2003; Liamis et al, 2008]:
- Diuretics: thiazides (such as bendroflumethiazide), indapamide, amiloride, loop diuretics (such as furosemide).
- Antidepressants: tricyclic antidepressants (such as amitriptyline), selective serotonin reuptake inhibitors (such as fluoxetine), monoamine oxidase inhibitors (such as phenelzine), venlafaxine.
- Antipsychotic drugs: phenothiazines (such as trifluoperazine), butyrophenones (such as haloperidol).
- Antiepileptics: carbamazepine, oxcarbazepine, sodium valproate.
- Desmopressin.
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