6.5.2.1 Diabetes insipidus

ChoiceDrugDosage
1st choiceDesmopressin nasal spray 10micrograms/metered spray; intranasal solution 100micrograms/mLDose: Intranasally, diabetes insipidus, treatment, 10-40micrograms daily in 1-2 divided doses
2nd choiceDesmopressin tablets 100micrograms, 200micrograms

Dose:
diabetes insipidus, treatment, initially 300micrograms daily in 3 divided doses;
maintenance 300–600micrograms daily in 3 divided doses; range 0.2–1.2mg daily

Or
Desmopressin sublingual tablets 60 micrograms, 120 micrograms, 240 microgramsDose:
diabetes insipidus, initially 180 micrograms daily in 3 divided doses; range 120-720 micrograms daily

Prescribing Notes

  • A single dose of desmopressin is also used as part of a test following fluid deprivation in the differential diagnosis of thirst and polyuria.
  • For nephrogenic diabetes insipidus, the usual treatment is a thiazide diuretic. Caution if due to lithium – refer to endocrinologist.
  • Desmopressin injection (4 micrograms/mL) may be indicated in unconscious patients (dose 1-4 micrograms daily by subcutaneous, intramuscular or intravenous injection).
  • Measurement of plasma sodium should be undertaken to guard against excessive water intake which would be reflected by a low plasma sodium. The frequency of monitoring should be individualised and more frequent monitoring will be required during the stabilisation phase.